PROGRAM NAME: Online EKG 101
Name: Date Of Birth:
State: Zip Code:
Home Phone: Cell Phone:
Email: Driver’s License Number:
Name: Phone: Cell:
Educational Background (Optional)
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: EKG 101
Non Refundable Cost
The Online EKG Program of $600.00 is Non-Refundable.
Students are responsible for paying for all applications and State/National Licensing or Certification exams through NCCT. Your Certificate of Completion For the course will take 4-6 weeks to receive by USPS Mail.
Additional Costs not Included in Tuition
Students are responsible for paying:
OTHER STUDENT RESPONSIBILITIES:
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:
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
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 enroll ent 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.
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Signed by Kristy Farook
Signed On: May 14, 2019
If you have questions about the contents of this document, you can email the document owner.
Document Name: EKG Enrollment
Agree & Sign