Pharmacy Technician Enrollment
PROGRAM NAME: Pharmacy Technician 101
June 25th 2019 (Evening)
August 29th 2019 (Evening)
August 3rd 2019 (Weekend)
November 5th 2019 (Evening)
Name: Date Of Birth:
State: Zip Code:
Home Phone: Cell Phone:
Email: Driver’s License Number:
Name: Phone: Cell:
High School Diploma, GED or Equivalent may be required by Some National Certifications for example: PTCB & NCCT
However, WMTC does not Require a High School Diploma for Enrollment.
Do You Have Any Felony Convictions?
If Yes, explain:
Who Referred You? (You must enter the person’s first and last name who referred you here for the person to be eligible for referral bonus)
EXPLANATION OF TUITION
Program Name: Pharmacy Technician 101
Non Refundable Cost
The Enrollment Fee of $100.00 is non-refundable/non-transferable, however, it is applied towards student’s tuition.
Students are responsible for paying for all applications and State/National Licensing or Certification exams through PTCB.
Additional Costs not Included in Tuition
Students are responsible for paying:
_________________________________________________________________________________________________________________________ PAYMENT AGREEMENT
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 COST: $1200 – $100(Non Refundable) = $1100
Payment Schedule:June 25th – July 31st 2019 (Evening Class )Monday – Friday 5:30 PM – 10:30 PM) 26 Days$300 Due On June 25th 2019$400 Due On July 12th 2019$400 Due On July 31st 2019
August 29th – October 4th 2019 (Evening Class )Monday – Friday 5:30 PM – 10:30 PM) 26 Days$300 Due On August 29th 2019$400 Due On September 13th 2019$400 Due On October 4th 2019
November 5th – December 11th 2019 (Evening Class )Monday – Friday 5:30 PM – 10:30 PM) 26 Days$300 Due On November 5th 2019$400 Due On November 20th 2019$400 Due On December 11th 2019
August 3rd – November 3rd 2019 (Weekend Class)Saturday & Sunday 5:00 PM – 10:00 PM) 26 Days
$400 Due On August 3rd 2019$300 Due On September 14th 2019$200 Due On October 12th 2019$200 Due On November 3rd 2019
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
A.) The drop date for any program is 10 business days prior to the start of the program.
B.) Notice of cancellations, 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. Not: 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 Date:
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 business days prior to the class start date.
Process For Withdrawal, Cancellation or Dropping a Program
FAILURE TO SUBMIT WRITTEN NOTICE BY DROP DATE
Failure to submit a written intent to cancel, withdraw, or drop at least 10 business days prior to the program start date will make the student responsible for the full tuition and costs.
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 refund and will be responsible for full tuition and costs.
Refund Policy Summation:
MUST DROP 10 BUSINESS DAYS PRIOR TO CLASS START DATE
REGISTRATION FEE IS NOT TRANSFERABLE, AND CAN NOT BE USED TO REGISTER FOR ANOTHER CLASS
TUITION FEES PAID ARE NOT TRANSFERABLE TO OTHER PROGRAMS OR OTHER INDIVIDUALS
Students who drop 10 business days prior to the class start date and have paid the tuition in full will be able to take the same program in the future by being placed on a waiting list. The waiting list does not guarantee a seat in the upcoming schedule. WMTC will make a good faith & reasonable effort to place the student in a schedule with available seat.
Accounts sent to collections:
If an account is sent to collections for non-payment or excessive late payments student will have the option to complete the training if the following conditions are met:
*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.
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 business days. Class being rescheduled does not constitute cancellation as long as the rescheduled class is held within 90 days of the original start date.
The following constitute grounds for dismissal from the training:
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:
Regular school attendance is a necessary part of the learning process and the means to graduation with a good education. Absenteeism, especially tardiness, is a behavior that is highly associated with dropping out of school. Regular attendance is essential for success in school.
Additional absences will result in being dropped from the program.
Before any dismissal of student from the program, school administrator will organize a meeting with director of nursing & the instructor to discuss student overall performance and behavior. If the recommendation is to give the student 1 additional chance, keeping in mind students best interest. As long as finding accommodation is not too difficult and make up is according to California Department of Public Health policy.
Example: If a one-on-one makeup 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.
OTHER STUDENT RESPONSIBILITIES:
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 transferability 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 Postsecondary 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 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.
Live Scan Fingerprinting (Externship Background Check Only).
Text Book (Loan has to be returned at the end of the course).
Drug Test For Externship
National Certification Exam Fees. (NCCT or PTCB)
Leave this empty:
Signed by Kristy Farook
Signed On: June 5, 2019
If you have questions about the contents of this document, you can email the document owner.
Document Name: Pharmacy Technician Enrollment
Agree & Sign