Western Medical Training Center

Student RNA Enrollment




Start Date: 



Applicant Information

Name: Date Of Birth:


Address:  City:     

State: Zip Code:  

Home Phone: Cell Phone:  

Email:  Driver’s License Number:  



Emergency Contact

Name:      Phone:  Cell:  

Address:  Relationship:


CNA License #   


Program Name: RNA 104                                                                        


Certification/Licensure Cost

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:

  • Physical examination and TB testing when required, which must be dated 30-60 days prior to going into clinical rotation. Note: that not all courses require physical examinations.
  • State examination fee or National Certification fees. 



 This Payment Agreement is entered into by and between Western Medical Training Center & , and they hereby agree upon the terms stated within this agreement.


Payment Cost : $250  FREE

  • The Certificate of Completion will be withheld until the tuition is paid in full. Note: Students cannot apply for the licensing examination without a Certificate of Completion.
  • Student acknowledges that the DROP DATE for any program 10 Calendar days prior to the start of the program.
  • Student further acknowledges that intent to withdraw, cancel, or drop MUST be submitted in writing before the drop date, no exception. After which, the student is responsible for full tuition costs and no refund will be issued.
  • In case the registration occurs after the drop date then the student agrees that he or she will be responsible for full tuition since the drop date has passed 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.

Printed Name:   



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

  1. Student must submit intent to withdraw, drop or cancel course in writing to school director;
  2. The school director will submit a statement of intent to the CFO;
  3. The CFO will review the student’s enrollment agreement;
  4. The student will be notified in writing of any financial obligations they have to the school as per program or course agreement. Invoice sent to the student will be considered an appropriate written notification.


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. 

Refund Policy Summation:

  1. Cancellations PRIOR to drop date with written notice: a full refund will be given (minus the $150.00 non-refundable enrollment fee);
  2. Student understands and agrees that he/she will be responsible for the full balance after the drop date of class.
  3. Cancellations AFTER the Drop date of class: No refund will be given;
  4. WMTC will allow the student to complete the program on later date or transfer the credit toward another program at WMTC after the request has been approved by the school director & CEO. No refund will be issued to the student.
  5. Student will be responsible for paying for all materials he/she obtained during the course.
  6. Student will be subject to the policies and agreements set forth in the payment agreement of this document.

Student Cancellation and Return Of Course Materials, Textbook, Equipment and/or Uniform

  • Student cancellation / drop must be provided to the school in writing.
  • If the school provided to the student any equipment, course materials, textbook and or uniforms, the student must return those materials to the college within 7 calendar days in new condition;
  • If the student fails to return those provided materials as required, the school may retain a portion of the tuition payment that is equal to the cost thereof, and thereafter refund any difference within 45 days as long as the cancellation / drop was 10 calendar days prior to the start date of the program.

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:

  • Conduct themselves in an unprofessional, inappropriate or unethical manner;
  • Conduct is deemed detrimental to peers, staff, faculty and / or administration;
  • Fails to meet the contracted, financial obligations to the college (included payment plans);
  • Fails to meet attendance policies;
  • Fails to meet academic standards;
  • Does not pass criminal background screening or live scan fingerprinting when required;
  • Does not pass CPR certification program prior to entering clinical training.

Missed Classes

  1. Students must complete all hours of the program to obtain their certificate of completion.
  2. Students are allowed NO Excused Days.
  • All missed days a required to be made up.
  • Students will have to pay $50.00 rescheduling fee for each missed day.
  • Students understand that if they are not able to make up a day before the graduation date they will not be able to obtain their certification of completion and can’t take the state exam.
  • One on One make up day option is the last resort, were the student can choose to pay $320.00 to make up one day
  1. Students who have 2 unexcused absences will be dropped from the program and will receive an “incomplete” grade.
  • Student will be responsible for Full Tuition
  • Student will have the option to complete the course at a later date once the tuition is paid in Full depending on schedule availability
  • Student will not be able to select a schedule of their choice.
  1. No Exceptions will be made to the above policy

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. 


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:

  1. That in the event that I obtained a loan to pay for this program, that I have the responsibility to repay the full amount of the loan plus interest, less the amount of any refund.
  2. If I am eligible for a loan guaranteed by the federal or state government and I default on the loan, both of the following may occur:
    1. The federal or state government or a loan guarantee agency may take action against me, including applying any income tax refund to which I am entitled to reduce the balance owed on the loan.
    2. I may not be eligible for any other federal student financial aid at another institution or other government assistance until the loan is repaid.
  3. Prior to signing this enrollment agreement, you must be given a catalog or brochure and a school performance fact sheet, which you are encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution. This institution is required to have you sign and date the information included in the school performance fact sheet related to the completion rate, placement rates, license examination passages rate, and salaries or wages, prior to signing this agreement.
  4. I certify that I have received the catalog, disqualifying Penal Code sections, school performance fact sheet, and information regarding completion rate, placement rates, license examination passage rates, and salary or wage information including in the school performance fact sheet, and have signed, initial, and dated the information provided in the school performance fact sheet.
  5. Any questions the student may have regarding this enrollment agreement that have not been satisfactorily answered by Western Medical Training Center may be directed to the:

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

  1. A student or any member of the public may file a complaint about this institution with the Bureau for private postsecondary education by calling 888-370-7580 or by completing a complaint form, which can be obtained on the Bureau’s Internet website listed below. bppe.ca.gov.address
  2. I am applying for admission to the program aforementioned. If accepted I understand that I will be bound by this agreement, the disclosure and conditions of enrollment, and that these are the complete and full agreement and that no oral promises or inducements have been made to me.
  3. I agreed to follow school rules, including regular course log-in, ethical conduct, and coursework progression if I failed to follow school rules or failed to make satisfactory grades, I understand I could be dismissed from the school.
  4. The school makes no representation’s whatsoever regarding transferring credits to any of the college or university. I should assume credits are not transferable unless I have written approval from another school. I understand certifications and licenses may require additional study and cost.
  5. I agree to resolve any dispute exclusively through mediation and if necessary binding arbitration.
  6. In consideration of the above agreement and tuition fees, the school will admit you to its classes and provide its services. I understand my rights and responsibilities.  This agreement contains all of the terms of our agreement.  I understand the written or oral changes to this enrollment agreement and/or promises or guarantees or inducements to enroll outside of this agreement are not permitted and I certified to the school that none have been made.
  7. This enrollment agreement may be terminated by the school for felony conviction or other serious criminal offenses, falsifying information, misrepresentation of self, unsatisfactory academic progress or excessive absences, conduct detrimental to the college, failure to comply with financial obligations or non-observance of other student regulations. If you are dismissed, you may appeal to the president or CEO of the school, whose decision will be final. 
  8. Textbook/course materials: students are responsible for the cost of replacing lost textbooks and course materials and will only be given one copy each. As per student agreement textbook has to be returned back to school at the end of the course. In case student lost the textbook he or she will be charged an amount listed on the textbook agreement page.
  9. Certification and licenses: The school’s educational programs lead to knowledge and skills for the state programs. We do not guarantee that our education programs will necessarily be sufficient to obtain any certification or licenses issued by a state, public or private agency. Certification and licenses may require additional study and costs. A third party may administer the examination and further study and a fee may be required.
  10. Financial aid: Currently WMTC programs are not eligible of Financial Aid:   if students make payments pursuant to an installment plan a separate installment contract will be entered and it is hereby incorporated by this reference into this enrollment agreement. Note: any holder of a consumer credit contract is subject to all claims and defenses, which the debtor could assert against the seller of goods or services, obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed amount paid by the debtor (FTC rule effective 5/14/1976)
  11. Catalog: the catalog contains important information about our curriculum, policies, and faculty. You should read the catalog prior to commencing studies. This student agreement has the most updated information about policies that apply to the courses and relationship between the school and student.  This agreement will supersede all information in the catalog if there are discrepancies in the catalog.
  12. Advertisements: advertisements are general and brief. Any impression or understanding obtained from advertisements should be evaluated with all the facts available to you as presented in this document and the enrollment agreement. If any impression conflicts with these documents the catalog, or any other documents, then this document and enrollment agreement shall take precedence.
  13. Career services assistance: to assist you in your employment efforts, you will need to follow our instructions regarding such things as resume preparation, job search, professional attire, and attending a sufficient number of interviews. The information you may have received about career opportunities is limited and general in nature and should not be relied upon for guidance for specific jobs, your particular situation, or your likelihood for success. Nobody knows with certainty what the conditions of a given career field or the economy will be in the future or when you graduate it may be necessary and desirable for you to relocate for a best career opportunities. Your career success will depend mainly on your attitude, the effort you put into your studies, your job search, and the job you finally except. Many pre-employment applicants are subject to additional criminal screening and drug testing. Therefore, we do not and we cannot guarantee you a job, and our employees are prohibited from making any representations or any promises in regard to employment. We reserve the right to refuse employment assistance for causes such as failure to cooperate and dishonest or illegal conduct.
  14. Student conduct: A harmonious and cooperative relationship among students, faculty and staff is important to us and to other students. Therefore, for the benefit of the students and staff, any conduct that is detrimental to the good morality or the calm learning environment of the school is prohibited.  It is expected that students maintain the highest level of ethical conduct. If you are aware of any wrongdoing or are subject to any misconduct from another student, we want you to inform the school administration immediately. Before we can act, we will need a brief written statement identifying the names of the other students and a factual statement of misconduct. Once we are properly informed, we will act to resolve the issue.
  15. Admission acceptance: should not be constructed as an express or implicit representation of the likelihood of your academic or career success. Your success as a student will depend primarily upon your motivation and your own efforts. For these reasons, college employees are only authorized to provide general information about our college and general information regarding careers. They are not authorized to make specific promises, guarantees, or any kind of inducements to enroll such as the likelihood that you will graduate, get a job, obtained a certain salary, or achieve any other goal you may have.
  16. Repeated courses: students receiving a failing course grade are subject to retaking the failed course at the student’s expense. Failed course components may be repeated once. If the student fails the retaken course component, the student will be dropped from the program. Students are eligible to petition to reenter the program at a later date.
  17. Course and schedule modifications: We may be required to change lecture content and schedules. While we will attempt to accommodate an individual student’s wishes and schedule, we will retain the absolute right to delay the start of, to cancel, or to modify our program and schedules. The class schedule will normally permit you to graduate on the date indicated, but this is only an estimate. The actual time required to graduate may be longer than estimated. You are entitled to graduate once you have met all of the graduation requirements. The school has a right to change start dates without prior notification.
  18. Payment of tuition/progress of program: the payment of tuition or other charges is solely to allow you to attend classes offered. The payment of tuition is in no way contingent upon satisfactory progress or placement or the provision of other services or benefits, which are provided strictly at the option of the school, and which may be modified or terminated at any time. As the student understands and agrees that he or she will be required to pay full tuition after the drop date of the program which is 10 calendar days prior to the start of the program.
  19. Disabilities: students must satisfactorily pass a physician’s medical examination for acceptance into the CAN, home health aide & acute care program. If you require special accommodations due to disability, you should notify the admissions representatives, director of nursing, school director, and or CEO. We will make reasonable accommodations, but in order to do so we will need relevant information regarding your disability and your suggestions for the reasonable accommodations that will satisfy you. We require this information in writing before you enroll. Please note that the school does not guarantee that these accommodations will be met.
  20. Discrimination: If you become aware of or are subject to unlawful discrimination, immediately bring it to the attention of the school director, director of nursing, or any instructor. This must be communicated in writing, stating objectively (factually) what transpired and the persons involved. Written documentation must be received before the school can act to resolve the situation.
  21. Release of information: you authorize any organization or person what whether or not listed on this document to provide or verify information and you release the school and any organization including but not limited to financial institutions, student loan services agencies, guarantee agencies, US Department of Education, credit bureaus. Or individual from any liability for exchanging such information or providing such information to the third parties. You authorize us to use any statements you write and any individual or group photographs of you for display in the school or advertisements or publications that we may publish from time to time.
  22. Severability: If any paragraph, sub paragraph, provision, or clauses is held invalid, said invalidity shall not affect any other paragraph, sub paragraph, provision, or clause that can have effect without being invalidated paragraph, sub paragraph, provision, or clause, and thus is severable one from the other.
  23. Release and waiver: Misunderstanding, misinformation, and misrepresentations sometimes occur. In order to have fast and convenient termination of any resulting conflict problems or liability, this release and waiver agreement is made. In the event that liability for any reason is not waived under this agreement and you are entitled to damages for any alleged breach, you agree that it would be impracticable or extremely difficult to fix actual damages and hereby agree that the amount of damages shall be liquidated and shall be the amount of tuition paid by or on your behalf, minus the cost of books and materials and any monies priory refunded. Further you agree to expressly waive the right to sue any individual stockholder, director, instructor, agent or employee of the school and agreed to proceed with any claims only against and seek recovery of damages solely from and against the school. If any other disputes, conflicts, problems, controversies or claims of any kind arise after the aforementioned verification period, you agreed to mediate and arbitrate as set forth above in this agreement and you will agree to submit any claim or dispute to mediation and arbitration no later than six months after leaving the school or forever waive such claims.
  24. Final and complete agreement: To preserve the integrity of the written agreements no oral representations, promises, inducements to enroll or agreement may be made by any employee which alters or contradicts this disclosure and conditions of enrollment and the enrollment agreement, which are the sole, full, final and binding agreement of enrollment. Any oral or written statements inconsistent with these documents are null, invalid, and void.
  25. Student acknowledges that he or she has been informed about the student catalog which is found on-line on the school website (wmtc.info) or they can request an electronic copy via email. Student agrees to decline a hard or printed copy of the student handbook.
  26. Student grading policy is found in the student catalog which states that student must receive 75% or better on all theory section of the course’s to satisfy and complete the course successfully. Clinical portion of all course have a Pass/Fail grade only. 
  1. Student agrees to follow all clinical site rules and regulations as stated in the student catalog. Student has been informed that if he or she does not follow school and clinical site rules they could be expelled from the program and school.
  2. Student understands that he or she will not be able to take any state exams or national certification exams until all financial and academic obligations have been satisfied. No exceptions will be made to this rule.
  3. 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, und

Leave this empty:

Signed by Kristy Farook
Signed On: December 20, 2017

Western Medical Training Center https://wmtc.info
Signature Certificate
Document name: Student RNA Enrollment
Unique Document ID: 5f533e0dd6a0bc0261d63f757a488e834b235db2
Timestamp Audit
July 6, 2017 2:53 pm PDTStudent RNA Enrollment Uploaded by okwudu o Farook - kristyfarook@gmail.com IP