Student Initials. The student acknowledges receiving a copy of this completed agreement, the school catalog, and written confirmation of acceptance prior to signing this contract. The student by signing this contract acknowledges that he/she has read this contract, understands the terms and conditions, and agrees to the conditions outlined in this contract. It is further understood that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the School Official. The student and the school will retain a copy of this agreement.
Student Initials. I understand that this is a legally binding contract. My signature below certifies that I have read, understood, and agreed to my rights and responsibilities, and that the institution's cancellation and refund policies have been clearly explained to me. Prior to signing this enrollment agreement, I have been given a catalog or brochure and a School Performance Fact Sheet, which I was encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. IOM is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates, placement rates, salaries or wages, and the most recent three-year cohort default rate, if applicable, prior to signing this agreement.
Student Initials. The student acknowledges receiving a copy of this completed agreement, the school catalog, and written confirmation of acceptance prior to signing this contract. The student by signing this contract acknowledges that he/she has read this contract, understands the terms and conditions, and agrees to the conditions outlined in this contract. It is further understood that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the School Official. The student and the school will retain a copy of this agreement. Student’s Signature Date Program Director’s Signature Date ADDENDUM: CONSUMER INFORMATION Per Section 1095.200 of 23 Ill. Adm. Code 1095: The following information must be submitted to the Board annually; failure to do so is grounds for immediate revocation of the permit of approval. DISCLOSURE REPORTING CATEGORY Basic Nursing Assistant Phlebotomy Electrogcard iogram Technician Patient Care Technician Patient Care Technician (11)
Student Initials. I certify that I have received the catalog, School Performance Fact Sheet, and information regarding completion rates, placement rates, license examination passage rates, and salary or wage information, and the most recent three- year cohort default rate, if applicable, included in the School Performance Fact Sheet, and have signed, initialed, and dated the information provided in the School Performance Fact Sheet. I UNDERSTAND THAT THIS IS A LEGALLY BINDING CONTRACT. MY SIGNATURE BELOW CERTIFIES THAT I HAVE READ, UNDERSTOOD, AND AGREED TO MY RIGHTS AND RESPONSIBILITIES, AND THAT THE INSTITUTION’S CANCELLATION AND REFUND POLICIES HAVE BEEN CLEARLY EXPLAINED TO ME. (Signature of Student) (Date) (Signature of School Official) (Date) (Title of School Official) THIS AGREEMENT IS LEGAL AND BINDING ONLY IF SIGNED BY THE STUDENT AND ACCEPTED BY THE INSTITUTION. ALL INSTRUCTION IS PROVIDED AT 00000 XXXXXXXX XX. NORTHRIDGE, CA 91325
Student Initials. 4. I understand that a new enrollment agreement must be completed in the event that the student delays his start date, changes the program and enrollment; or drops from the program and re-enrolls at a later date. Student initials
Student Initials. The student acknowledges receiving a copy of this completed agreement, Excelsior Healthcare Academy catalog, and written confirmation of acceptance prior to signing this contract. The student by signing this contract acknowledges that he/she has read this contract, understands the terms and conditions, and agrees to the conditions outlined in this contract. It is further understood that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and Excelsior Healthcare Academy Official. The student and Excelsior Healthcare Academy will retain a copy of this agreement. Student’s Signature Date Program Director’s Signature Date
Student Initials. UNIVERSITY CONVICTED SEX OFFENDER POLICY: The university has determined that convicted sex offenders, whether required to register or not, pose a significant, clear and present danger to residents living in Contracted Housing, and are not permitted to live in Contracted Housing. I hereby certify that I am NOT a convicted sex offender and am eligible to rent and reside in Contracted Housing. Student Initials:
Student Initials. The student acknowledges receiving a copy of this completed agreement, the school catalog, and written confirmation of acceptance prior to signing this contract. The student by signing this contract acknowledges that he/she has read this contract, understands the terms and conditions, and agrees to the conditions outlined in this contract. It is further understood that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the School Official. The student and the school will retain a copy of this agreement. Institutional Disclosures Reporting Table Reporting Period: July 1, 2012 - June 30, 2013 INSTITUTION NAME: JCM INSTITUTE Indicate all ways the disclosure information is distributed or made available to students at this institution: X Attached to Enrollment Agreement X Provided in Current Academic Catalog X Reported on School Website Other: NASIC NURSING AIDE EKG BASIC AND ADVANCE PATIENT CARE TECHNICIAN PHLEBOTOMY CPR Physical Rehab Aide Medical Coding and Billing
Student Initials. This agreement is a legally binding instrument. Both sides of the contract are binding only when the agreement is accepted, signed, and dated by the authorized official of the school or the administrators. Read all terms before signing. You are entitled to an exact copy of this agreement and any disclosure pages you sign. If the student receiving this document does not understand what is written herein due to an English language comprehension deficiency, the student has the right to a verbal explanation of the terms set forth. Signing the document institutes that the student understands and agrees to the terms set forth. STUDENT ACKNOWLEDGMENT: I understand this is a legally binding contract. My signature below certifies that I have read, understood, and agreed to my right and responsibilities, and that the institution's cancellation and refund policies have been clearly explained to me. Signature of Student Date Signature of School Official Date ENROLLMENT AGREEMENT 000 X. Xxxxxxx Xx. Xxxxx 000 Xxxxx, XX 00000 Ph. (000) 000-0000 | Fax (000) 000-0000 Email xxxx@XxxxxxxxxxXxxxxxxXx.xxx xxx.XxxxxxxxxxXxxxxxxXx.xxx STUDENT INFORMATION STUDENT NAME: ADDRESS: TELEPHONE: EMAIL: DATE OF BIRTH: SOCIAL SECURITY NO: PROGRAM INFORMATION PROGRAM/COURSE TITLE: Nurse Assistant Training Program DATE OF ONLINE ENROLLMENT/REG FEE WAS PAID: / / (Cancellation period ends 7 days from above date) PROGRAM START DATE: ANTICIPATED END DATE: TIME CLASS BEGINS: 7AM TIME CLASS ENDS: 3:30PM TOTAL CREDIT/CLOCK HOURS: 168 FINANCIAL INFORMATION TUITION FEES Registration Fee ($250 non- refundable) 300.00 Uniforms 50.00 Tuition 1115.00 Equipment 0.00 STRF Fee (non-refundable) 0.50 State Exam Registration Fee 125.00 Text Books/ Learning Resources 89.50 Live Scan Finger Prints 70.00 Lab Supplies/ Kits 0.00 Tutoring NA Electronic Record Keeping Fee 50.00 CPR NA Promotional Discount (If Applicable) TOTAL: $1800.00
Student Initials. In conclusion, I agree to maintain regular attendance and abide by the rules and regulations of the school. I understand that regular attendance is my obligation and the school’s policy regarding absence and make-up as stated in the school bulletin will apply to all students. I am aware that I can bring my own tools or borrow certain items from the school. There are no medical conditions that prevent me from taking this training. The school reserves the right to make changes in its structure, policy, and procedures as circumstances permit. I grant permission to the school to use my class photographs for educational and/or marketing purposes. The school reserves the right to make changes in equipment and materials to adjust the curriculum as it considers necessary to meet the demands of advances in technology or changes in the workplace. Student Initials: I authorize relationship to receive information regarding my academic and financial status with Mobile Technical Training. Student Initials: I acknowledge reading and receiving a copy of this agreement, the school bulletin, and a written confirmation of my acceptance in class. I have read and fully understand all of the information provided in this contract (2 pages) and agree to follow all policies as stated in the enrollment contract and school bulletin. Applicant’s Signature: Date: School Director’s Signature: Date: Parent/Guardian Signature if necessary: Date: This agreement is not binding until three business days after signing by both parties. The student and the school will retain a copy of this agreement.
