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 Signature: Date: School Official Signature: Date: Parent/ Guardian Signature: Date:
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. 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. 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. Agreement is Binding This Enrollment Agreement Contract and all contract annexes shall be binding only when they have been fully completed, signed and dated by the student and the Director of the Institute of Structural Medicine or authorized representative of the school prior to the time instruction begins. Student Initials Changes in Agreement Any changes to this Enrollment Agreement Contract or contract annexes shall not be binding on either the student or the Institute of Structural Medicine unless such changes are acknowledged in writing by both the authorized representative of the Institute of Structural Medicine and the student. Student Initials Student Initials Notice To The Buyer (Student) Do not sign this agreement before you read it or if it contains any blank spaces. This is a legal instrument. All pages of the contract are binding. Read both sides of all pages before signing. You are entitled to an exact copy of the agreement, the school catalog, and any other document that you are required to sign. You will be required to sign a statement acknowledging receipt of all applicable documents. Cancellation of This Contract If you have not started training, you may cancel this contract by providing written notice of cancellation to the school at its address shown on the contract. The notice must be postmarked no later than midnight of the fifth business day prior to the date the first class commences (excluding Sundays and holidays), following your signing of this contract. The written notice must be personally or otherwise delivered to the school within this time limit. In event of dispute over timely notice, the burden of proof of service rests with the applicant. Unfair Business Practices It is an unfair business practice for the school to sell, discount or otherwise transfer this contract or promissory note without the signed written consent of the student or his/ her financial sponsors and a written statement notifying all parties that the cancellation and refund policy continues to apply. Private Vocational School Acknowledgement (PVSA) Notice This school is licensed under chapter 28c.10 RCW; inquiries or complaints regarding this or any other private vocational school may be made to: Workforce Training and Education Coordinating Board 000 Xxxxx Xxxxxx XX P.O. Box 43105 Olympia, Washington 98504-3105 (000) 000-0000 xxxxxxxxx@xxx.xx.xxx Student Initials Notice of Financial Obligation
