Common use of FINANCIAL AGREEMENT Clause in Contracts

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 2017 N/A N/A N/A N/A 2019 2018 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 2018 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 2017 N/A N/A N/A 2018 N/A N/A N/A 2019 2017 N/A N/A N/A 2018 N/A N/A 2019 N/A 2017 N/A N/A 2018 N/A N/A 2019 2017 N/A N/A 2018 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 2018 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 2017 N/A N/A N/A N/A N/A N/A N/A 2019 2018 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 2019 N/A N/A N/A N/A 2019 2020 N/A N/A N/A N/A Students Initials: Date: 0000 X2019 N/X XA N/X XA N/X XA N/X XA N/X 2019 A 2020 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 2019 N/A N/A N/A 2020 N/A N/A N/A 2019 N/A N/A N/A 2018 2020 N/A N/A N/A 2019 N/A N/A N/A 2018 2020 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 2020 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X2019 N/X XA N/X XA N/X XA N/X XA N/X 2019 A 2020 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 2019 N/A N/A N/A N/A N/A N/A N/A 2019 2020 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicableimportant, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” 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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 THE TOTAL CHARGES THE STUDENT IS OBLIGATED TO PAY UPON ENROLLMENT: $1,595.00 Charges are for the period of attendance and estimated for the entire program. Payment plan options available. SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition I understand I am responsible for payment of any charges and agree to pay the hospital the regular rates or charges for all hospital and medical services renderedto me. If I am covered by a third party (for example, Blue Cross & Blue Shieldor other insurance or managed care, or a benefit program such as Medicare or Medicaid), then the third party may pay all or a part of Institute of Healthcarethe hospital rates or charges. If so, Inc academic standards I agree to pay those rates or charges that are not covered or paid by that third party, and policiesto the extent permitted by law are properly payable by me, as soon as I receive a bill. If I do not pay my bill I agree to pay the hospital any collection costs including attorney's fees, collection agency fees, and court costs. The hospital reserves the right to accept periodic installment payments without waiving its rights to demand payment in full. If I do not agree, I understand a consultation with our Patient Advisor is required before non-emergent services will be rendered. MEDICARE AND OTHER GOVERNMENTAL PROGRAMS: I agree that the information I have given in applying for benefits under Medicare, Medicaid, Maternal or Child Health Service s or other governmental programs is complete and accurate. The Institute of Healthcare is hospital may give the appropriate state and/or federal agencies (including but not currently recognized with institutional accreditation recognized by limited to, the United States State Department of EducationSocial Services and the federal Social Security Administration or i ts fis cal intermediaries), any information about me that I have that may be necessary to process claims for such payment. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wagesThe hos pital, and the most recent three- year cohort default rate, doctors and alliedhealth care providers treating me may make direct claims for payment. VETERANS: Please indicate if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “I understand that this or your spouse is a legally binding contractveteran of the US Armed Forces. My signature below certifies that State the name of your spouse if he/she is a veter an. Please identify the branch of the Armed Forces and state the appropriate dates of service: I have readHAVE READ THIS PATIENT AGREEMENT, understoodOR IT HAS BEEN READ TO ME, and agreed to my rights and responsibilitiesAND I UNDERSTAND IT, and that the Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of HealthcareALL OF MY QUESTIONS HAVE BEEN ANSWERED TO MY SATISFACTION, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER AND I FREELY AGREE TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS TERMS AND DEFENSES CONDITIONS IN THE AGREEMENT THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP ARE APPLICABLE TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD PATIENT EXCEPT THOSE SPECIFICALLY NOTED ABOVE BY ME AS NOT APPLYING. **************************************************************** DATE: TIME: SIGNATURE OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: DatePATIENT PRINT PATIENT NAME:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 4 AND 8 and or 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 THE TOTAL CHARGES THE STUDENT IS OBLIGATED TO PAY UPON ENROLLMENT: $1,595.00 Charges are for the period of attendance and estimated for the entire program. Payment plan options available. SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 N/A N/A N/A N/A 2019 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 N/A N/A N/A N/A N/A N/A N/A 2019 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 4 AND 8 and or 12 WEEK COURSES OFFERED 2018 2019 N/A N/A N/A N/A 2019 2018 N/A N/A N/A N/A Students Initials: Date: 0000 X/X X/X X/X X/X X/X 2019 2018 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A N/A 2019 N/A N/A N/A 2018 N/A N/A 2019 N/A N/A 2018 N/A N/A 2019 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X/X X/X X/X X/X X/X 2019 2018 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 2019 N/A N/A N/A N/A N/A N/A N/A 2019 2018 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date:

FINANCIAL AGREEMENT. In addition to all of Institute of Healthcare, Inc academic standards and policies, I understand that The Institute of Healthcare is not currently recognized with institutional accreditation recognized by the United States Department of Education. Students are not able or eligible to participate in federal financial aid programs in association with the Institute of Healthcare, Inc. With that being said, the applicant will be withdrawn from the course for failure to meet financial obligation. “Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion rates placement rates, license examination passage rates, and salaries or wages, and the most recent three- year cohort default rate, if applicable, prior to signing this agreement. “As a prospective student, you are encouraged to review this catalog prior to signing an enrollment agreement. You are also encouraged to review the School Performance Fact Sheet, which must be provided to you prior to signing an enrollment agreement.” “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 Institutions cancellation and refund policies have been clearly explained to me.” Applicant Signature Applicant Print Name Date Authorized Employee of Institute of Healthcare, Inc. Signature Print Title Date “NOTICE” “YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED IN ORDER TO FINANCE THE COST OF THE EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS INSTITUTION, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.” TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1,595.00 ESTIMATED TOTAL CHARGES FOR THE ENTIRE EDUCATIONAL PROGRAM: $1,595.00 SCHOOL PERFORMANCE FACT SHEET EMERGENCY MEDICAL TECHNICIAN PROGRAM: 4, 8 and 12 WEEK COURSES OFFERED 2018 2017 N/A N/A N/A N/A 2019 2018 N/A N/A N/A N/A Students Initials: Date: 0000 X2017 N/X XA N/X XA N/X XA N/X XA N/X 2019 A 2018 N/A N/A N/A N/A N/A You may obtain from the institution a list of the employment positions determined to be in the field for which a student received education and training. Please request from Administration. 2018 N/A N/A N/A 2019 2017 N/A N/A N/A 2018 N/A N/A N/A 2019 2017 N/A N/A N/A 2018 N/A N/A 2019 N/A 2017 N/A N/A 2018 N/A N/A 2019 2017 N/A N/A 2018 N/A N/A Student’s Initials: Date: Initial only after you have had sufficient time to read and understand the information. License Examination Passage Rates (includes data for the two calendar years prior to reporting) 0000 X2017 N/X XA N/X XA N/X XA N/X XA N/X 2019 A 2018 N/A N/A N/A N/A N/A Licensure examination passage data is not available from the state agency administering the examination. We are unable to collect data from graduates. Student’s Initials: Date: 2018 2017 N/A N/A N/A N/A N/A N/A N/A 2019 2018 N/A N/A N/A N/A N/A N/A N/A Student’s Initials: Date: