Required fields are indicated with an asterisk (*).

Student Information:

* ID/SSN Number:
* First: Middle: * Last:


Electronic Signature Agreement:

Under the Federal Electronic Signatures in Global and National Commerce Act, before Lindsey Wilson College ("LWC") may accept your documents electronically, we must provide you with certain of the following information and you must affirmatively agree to the following and thereafter not withdraw your agreement.

By agreeing below and submitting it to LWC via the internet, I acknowledge that:
  • I have read and understood the foregoing Electronic Signature Agreement, and that I intend to rely upon it and understand that LWC will rely upon it, and that I intend to be bound thereby.
  • I understand and agree that my electronic signature is the equivalent of a manual signature and that LWC may rely on it as such in connection with any and all agreements I may enter into with LWC including but not limited to this Electronic Signature Agreement.
  • I further acknowledge and agree that it is my obligation to immediately advise LWC in the event that I withdraw my consent to this Electronic Signature Agreement.
  • I acknowledge and agree that various security and verification procedures adopted by LWC in connection with documents on which I have affixed my electronic signature constitute a "qualified security procedure" under the Federal Electronic Signatures in Global and National Commerce Act, and that all such signatures are "secure electronic signatures" (as defined by the Federal Electronic Signatures in Global and National Commerce Act) attributable to the person whose name is entered below.
  • I acknowledge and agree that in the event that any person known to me (whether it be a family member, member of my household or otherwise) misappropriates any of the security devices connected with my LWC account or id and such misappropriation could not reasonably be detected by LWC, LWC shall have the right to treat all resulting electronic signatures as though they were affixed by the person whose name is entered below.
  • I acknowledge and agree that the individual completing this electronic account application is the individual in whose name the form is being submitted.
I,
, hereby authorize Lindsey Wilson College to directly apply to my student account all earnings from my Federal Work-Study position. This authority is to remain in effect until LWC has received written notification from me of its termination. I understand that my student account can be viewed at anytime using Banner Web.

* I agree to all of the above and consider this my digital signature, signed 11/01/2014.