CNA Enrollment F
PROGRAM NAME: CNA 101
Start Date/Completion Date:
April 10th 2017 Weekday
April 22nd 2017 Weekend
April 17th 2017 Evening
Name: Date Of Birth:
State: Zip Code:
Home Phone: Cell Phone:
Email: Driver’s License Number:
Name: Phone: Cell:
Degree’s Earned: Associates Bachelor’s Masters Doctorate
Years of Study:
High School Completion, GED or Equivalent WMTC does not Require High School Diploma for Enrollment.
Some National Certifications may require GED or Equivalent, for example: PTCB & NCCT
I certify that I graduated from:_ High School on
or Earned my GED or HS Equivalency on:
Do You Have Any Felony Convictions?
If Yes, explain:
EXPLANATION OF TUITION
Program Name: CNA 101
Non Refundable Cost
The Enrollment Fee of $100.00 is non-refundable, however, it is applied towards student’s tuition.
Students are responsible for paying for all applications and State/National Licensing or Certification exams through CDPH, NCCT & PTCB.
Additional Costs not Included in Tuition
Students are responsible for paying:
This Payment Agreement is entered into by and between Western Medical Training Center & , and they hereby agree upon the terms stated within this agreement.
PROGRAM NAME: CNA 101
PROGRAM COST: $1800
**There is NO Penalty For Early Payment**
I certify that I have read, understand and agree to the Payment Agreement as outlined herein, and I have received a true copy of this document and will retain said copy for my records.
CANCELLATION OF ENROLLMENT/ REFUND POLICY
Student’s Right To Cancel/Withdraw/Drop from Program
A.) The drop date for any program is 10 calendar days prior to the start of the program.
B.) Notice of cancellation, withdrawal, or drop must be submitted in writing before the program drop date, and must be signed and dated by the student or legal guardian. Note: A student’s lack of attendance does not mean that student will be dropped from the program.
(Example: If student has registered for an upcoming class and never shows up for the class, and does not provide a written notice prior to the drop date; then the student will receive a failing grade for the course and will not be eligible for a refund).
Cancellation/Withdrawal/Drop Prior to Start of Program
Students may cancel, withdraw, or drop from a program prior to the drop date. Cancellations, withdrawals or drops must be submitted in writing no later than 10 calendar days prior to the start of the program (drop date).
Process For Withdrawal, Cancellation Or Dropping A Course
FAILURE TO SUBMIT WRITTEN NOTICE BY DROP DATE:
Failure to submit a written intent to cancel, withdraw, or cancel at least 10 calendar days before the start of the program (drop date) will make student responsible for full tuition and costs. (initial)
Cancellation of Enrollment After Start of Program
Students who cancel, withdraw or drop from a program after the start of the program, will not be entitled to a refund and will be responsible for full tuition and costs.
*Important Note – Student will be responsible for any charges the college has paid on their behalf for the above stated program including but not limited to: Live Scan Fingerprinting, Textbook, Workbook, Uniform, CPR certification course, Stethoscope, Gait belt, and all other items related to the specific course in which the student has enrolled. The items listed above are not provided in all courses.
Refund Policy Summation:
Student Cancellation and Return Of Course Materials, Textbook, Equipment and/or Uniform
WMTC Course Or Program Cancellation
If the school cancels the program before the first day of class, the school will refund all money including deposit paid to students within 45 calendar days. Class being rescheduled does not constitute cancellation as long as the rescheduled class is held within 90 days of the original start date.
Suspension and Dismissal
Students are expected to conduct themselves professionally at all times, and to follow protocols and expectations as outlined in the policies and procedure sections of the student handbook.
The school reserves the right to suspend or dismiss any students who:
All theory, lab and clinical absences must be supported by medical documentation. Students unable to provide acceptable medical documentation supporting their illness are subject to failing the missed portion of the program. Extenuating circumstances will be individually weighed by administration. The school/program director will make every effort to schedule a make-up class without additional financial requirements if there is space available in another class. All unexcused missed classes will have to be made up at a fee of $50.00 per day. Students can miss no more than 3 days of the program after which the student will be dropped from the course and rescheduled to a later class date.
One-on-One Instructor Make Up Class
Students will be financially responsible for payment of instructor for one-on-one teaching for any missed days.
If a one-on-one make up class is required, the student will be charged $40 per instructional hour for each hour of missed theory, lab or clinical time, i.e. 8 hours missed x $40 = $320.
NOTICE CONCERNING TRANSFER-ABILITY OF CREDITS AND CREDENTIALS EARNED AT OUR INSTITUTION
The transfer-ability of credits you earned at Western Medical Training Center is at the complete discretion of an institution to which you may seek to transfer. Acceptance of the program completion certificate you earn in our school training programs is also at the complete discretion of the institution to which you may seek to transfer. If the credits or certificate that you earn at this institution are not accepted at the institution to which you seek to transfer you may be required to repeat some or all of your coursework at that institution. For this reason you should make certain that your attendance at this institution will meet your educational goals. This may include contacting an institution to which you may seek to transfer after attending Western Medical Training Center to determine if your credits or certificate will transfer.
I hereby acknowledge the following:
Bureau For Private Post Secondary Education
Physical address: 2535 Capital Oak Dr., Suite 400, Sacramento California, 95833
Mailing address: PO Box 980818, West Sacramento, CA 95798-0810
Phone Number: 916-431-6959 / Toll Free: 888-370-7589 / Fax Number: 916-263-1897
2 Sets of Uniform.
Live Scan Finger Printing (Background Check).
Text Book (Always has to be returned at the end of the course).
State Exam Fee.
Physical Examination & PPD Skin Test.
X-Ray (Only if PPD is positive)
National Certification Exam Fees. (NCCT or PTCB)
State exam handbook
Print Student Name Date
I verify that the stated information in this Enrollment Agreement is true and accurate to the best of my knowledge. I agree that the course enrollment procedure and explanation of tuition and fees has been fully explained to me. I acknowledge that I have received a copy of the enrollment agreement form and the explanation of tuition, fees and cancellation of enrollment, student handbook or catalog and performance fact sheet.
I understand that in consideration to all applicants, seat availability for this course is offered on a first-come first-served basis. Acceptance is dependent upon the successful completion of the application form, payment of enrollment fee, live scan fingerprinting application and submission, physician statement of eligibility to train.
I understand that there is limited seat availability and that my application does not guarantee me a seat until confirmed by administration.
I understand that this enrollment agreement when signed by the student and accepted by Western Medical Training Center is a legally binding contract. My signature below certifies that I have read, understood, and agree to my rights and responsibilities, and that the institutions cancellation and refund policies have been clearly explained to me.
The clinical training is designed to provide you with the essential skills necessary to enter the health care profession as a Certified Nurse Assistant. Please keep in mind that we are a guest in the facility we use for the required clinical experience. It is essential that we act in a professional manner at all times.
A. All lifting of patients must be done with a qualified staff member, NO EXCEPTIONS!> B. Bed/wheelchair/shower chairs must be in the locked position before all transfers. C. Never leave a patient alone in a shower chair or on a toilet. D. Bed Rails must be left up while the patient is in the bed, if required. E. Leave bed in the lowest position possible after completing a skill. F. Never do anything that you are not trained to do or is outside your scope of practice.
I have read, understand and agree to comply with the rules stated above.
Method of Student Evaluation For CNA Program
Certified nursing assistant students will be graded in two parts…
Students will be graded by means of taking a quiz for each theory module. Quizzes will be averaged to give the final theory grade. A final theory grade will be divided as follows. Test and quizzes will equal 60% of the theory grade,20% for attendance and professionalism, and the remaining 30% will be assignments and projects. Students require a minimum of 75%/ C to pass the didactic portion of the program.
1.) If the student does not pass the theory portion of the program he or she will be required to repeat the theory portion until the obtain a passing grade.
B) CLINICAL PERFORMANCE/PARTICIPATION
Students will be graded by means of clinical performance objectively evaluated by the instructor. Each student will be required to successfully obtain at least one set of vital signs for their client. In addition the student will be required to satisfactorily assist their client with personal care tasks. A final Pass/Fail grade will be awarded to each students upon completion of the clinical training portion of the program
**STUDENTS MUST PASS BOTH PORTIONS ABOVE TO QUALIFY FOR THE STATE EXAM***
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Signed by Kristy Farook
Signed On: February 9, 2017
If you have questions about the contents of this document, you can email the document owner.
Document Name: CNA Enrollment F
Agree & Sign