St. Cloud State University

Impact Diversion Alcohol Education Program

 You must complete the
appropriate eCheckup TO GO Assessment
prior to your class.
You are required to print off your
input summary and bring it with you to class,
along with a photo ID.  Failure to do so will result
in rescheduling your class for an additional fee.
If you have questions, please call the
IMPACT Office at 320-308-4179.  
Office hours are 8am-4:30pm Monday-Friday.



  

****IMPACT Diversion Program Refund Policy***
1. Non-Refundable Fee: I understand that staff member time and materials are utilized for IMPACT, and that the fee I pay when I schedule IMPACT will not be refunded if I am late for, do not attend, properly reschedule, do not bring the appropriate materials, or fail to complete IMPACT for any reason. I also understand that my failure to complete IMPACT for any reason will result in my need to reschedule and pay the entire fee again.  If I am late or do not bring the proper class materials, I may be able to reschedule for the rescheduling fee of $25.  I understand that my failure to pay the fee does not exempt me from having to pay for the course multiple times if I am late for, do not attend, or do not properly reschedule for a course that I have registered for.  I understand that if I register and pay for a St. Cloud Diversion Class ($230) and it is later discovered that I was not eligible for the program, no money will be refunded.   
2. Violation of the Code of Conduct: I understand that my failure to schedule IMPACT may result in additional charges of violating the Student Code of Conduct, additional sanctions, and/or a “hold” placed on my ability to register for academic classes until I have completed IMPACT.
3. I understand that my requirement to attend IMPACT will not be met if I do not attend or come late for my scheduled IMPACT class (note: doors lock promptly at start time) or I leave before the class is completed or I fail to participate appropriately or disrupt the class. I also understand that in these circumstances I may be asked to leave the class or I come to IMPACT under the influence of alcohol or other drugs or I disrupt the class in any way including but not limited to leaving early, text messaging, or interfering with the instructor or other participants, or I do not bring the appropriate materials to class (photo ID and eCHECKUP TO GO Input Summary).  I understand that it is my responsibility to have all materials needed when I show up for the class. I understand that if I commit another violation of the Student Code of Conduct I may be required to attend another IMPACT with an additional fee or fulfill another sanction requirement.

By submitting this registration, I certify that: 
1. I have read this form and understand what is required. I will contact the administrator who referred me if I have questions. 
2. I authorize University staff to confirm my attendance at IMPACT and to release information about my behavior in IMPACT/Diversion if I fail to meet the requirements for completion. 
3. If requested, I will provide a copy of the Police Report or other documentation related to the incident which led to my sanction to attend IMPACT/Diversion.