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. 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 Signature: Date: School Official Signature: Date: Parent/ Guardian Signature: Date:
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. 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 A Safe Haven Foundation 0000 X. Xxxxxxxxx Road Chicago, IL 60608 P: 000-000-0000 F: 000-000-0000 xxxx://xxx.xxxxxxxxxx.xxx/ Email: xxxx@XXxxxXxxxx.xxx BRIDGE WELDING ENROLLMENT AGREEMENT STUDENT INFORMATION STUDENT NAME: ADDRESS: CITY/STATE/ZIP: PHONE NUMBERS: H) C) W) E-MAIL ADDRESS: SOCIAL SECURITY #: STUDENT ID #: EMERGENCY CONTACT: RELATIONSHIP: TELEPHONE #: PROGRAM INFORMATION DATE OF ADMISSION: / / PROGRAM / COURSE NAME: DESCRIPTION OF PROGRAM / COURSE: PREREQUISITE COURSES & OTHER REQUIREMENTS FOR ADMISSION TO PROGRAM / COURSE: ADDENDUM CONSUMER INFORMATION All schools are required to make available, at a minimum, the following disclosure information clearly and conspicuously on their 1) internet website, 2) school catalog, and 3) as an addendum to their Enrollment Agreement: • The number of students who were admitted in the program as of July 1 of that reporting period. Expected Outputs FY18 Actual FY19 Actual FY19 Goal (See attached) 50 50 50 • The number of additional students who were admitted in the program during the next 12 months and classified in one of the following categories: new starts, re-enrollments, and transfers into the program from other programs at the school. Not applicable. The nine week training programs are offered in multiple cohorts throughout the year. As such, individuals are placed in the next training cohort rather than transferring into the program once training has started. • The total number of students admitted in the program during the 12-month reporting period. • The number of students enrolled in the program during the 12-month reporting period who: transferred out of the program and into another program at the school, completed or graduated from a program, withdrew from the school, and are still enrolled. • The number of students enrolled in the progr...
