BASIC NURSING ASSISTANT TRAINING PROGRAM ENROLLMENT AGREEMENT. STUDENT INFORMATION Student Name Date of Birth Student ID No. Social Security No.

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1 LARLIN Medical Staffing & Training Center 6912 Main St., Suite 110, Downers Grove, IL Tel. No Fax No BASIC NURSING ASSISTANT TRAINING PROGRAM ENROLLMENT AGREEMENT STUDENT INFORMATION Student Name Date of Birth Student ID No. Address Social Security No. City State Zip Home Phone No. Cell No. Work Phone No. Emergency Contact Relationship Phone No. PROGRAM INFORMATION Date of Admission Program/Course Name Basic Nursing Assistant Training Program Program/Course Description This course is designed to educate the student Nurse Assistant in understanding and performing the tasks required to assist clients who are unable to perform their own-self-care. This course will use the cognitive, effective, and psychomotor domains of learning to instruct students concerning the scientific principles of care. A laboratory section will be incorporated to provide simulated experience in the practice and perfection of technical skills. The total required number of hours is 120. The skills of this foundation course covers basic knowledge in nursing theory and practice, and includes basic human needs, environmental and patient safety, techniques of communication, first aid, infection control ethics, personal care and mental illness (Alzheimer s Disease). You will also become CPR certified in this course. A supervised clinical practicum will reduced reality shock and allow the completion of this course of study, and will give the student nurse assistant the essentials needed to function effectively as a member of the health care team. The Basic Nursing Assistant Training Program is designed to prepare the nursing assistant to work under the direction of a licensed nursing professional in a long-term care facility like hospitals and nursing homes, and in private clinics, laboratories, home health agencies, and private care. After completion of the course, the student will be eligible to take the Illinois Nurse Aide Competency Examination. Students who pass this examination will be entered in Illinois Nurse Aide Registry of the Illinois Health Care Worker Registry. 1

2 PROGRAM INFORMATION (continued) Prerequisite Courses & Other Requirements for Admission to the Program/Course The following are the registration requirements for the Basic Nursing Assistant Training program. Student must have a proof of High School diploma or a GED to enroll in course. Completion of the health requirements, e.g. physical examination and TB test. Background check Payment of $50.00 non-refundable registration fee Tuition fee down payment of $ Deposits or down payments shall become part of the tuition. Pass the admission test Completion of the registration packet. Program/Course Objectives Upon completion of this course, the student will be able to: Perform basic nursing skills for clients in a variety of settings. Safely and effectively perform personal care skills. Recognize the psychological, emotional, physical and spiritual needs of clients. Demonstrate appropriate attitudes in giving nursing care. Observe client/patient confidentiality. Exhibit proper ethical and legal behavior in giving nursing care. Demonstrate effective communication and interpersonal skills. Demonstrate behavior that maintains the rights of the client. Perform nursing care with regard to the principles of infection control. Acquire the proper knowledge and skills to respond to emergencies Prepare the student nursing assistant to take the State Nurse Aide Board examination. Program Start Date Program End Date Full-Time Part-Time Day Evening Class Meets - Theory Time Start Time End 5:00 PM 9:30 PM Class Meets - Clinical Time Start Time End 6:00 AM 2:45 PM Number of Weeks 5 weeks Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Total Credit or Clock Hours 120 clock hours 2

3 CONSUMER INFORMATION All schools are required to make available, at a minimum, the following disclosure information clearly and conspicuously on their 1) internet website, 2) school catalog, and 3) as an addendum to their Enrollment Agreement: 3

4 FINANCIAL AID LarLin Medical Staffing & Training Center, Inc. does not provide financial aid but accept students supported by different civic organizations, associations, clubs, foundations, churches, businesses and state programs. TUITION & FEES Registration Fee $ Non-refundable Tuition $ Contact Hours for Theory and clinical combined Book & Supplies $ $70 - Mosby s Textbook for Nurse Assistants, 8 th Ed $10 - Stethoscope $10 - Gait belt $ 0 - badge Misc. Expenses $ $10 - Background Check paper work $35 - Cardiopulmonary Resuscitation Other $ Testing Fee for Illinois Nurse Aide Competency Examination only Total Cost $ 1,000.00* Basic Nursing Assistant Training Program *Total Cost does not include cost of White Scrubs, Criminal Background Check, Physical Examination, TB Testing and X-ray, if needed. Cost of each may vary from facility to facility. TUITION & FEES REFUND POLICY The school will issue refunds of tuition and fees to the students in a prompt manner, when students give written notice of cancellation, withdrawal or when a program is discontinued by the school. 1. As a matter of courtesy, student should submit a written notification to the school in person or by registered mail, of their intention to cancel or withdraw from a program. However the school does not require notification of withdrawal as a condition of making funds. 2. Any student applying for a program that is discontinued by the school shall receive a complete refund of all fees and/or tuition paid. 3. Refunds shall be made within 30 days from the last day of the attendance if written notification has been provided to the institution by the student; otherwise, refunds shall be made within 30 days from the date the institution terminates or determines that the student has withdrawn. 4. Applications not accepted by the school shall receive a refund of all tuition and fees paid within 30 calendar days after the determination of non-acceptance is made. 5. The school may refund any book and materials fees when book and materials are returned to the school unmarked and student has provided the school with a notice of cancellation. 6. Should the student s enrollment be cancelled or should the student withdraw for any reason, all funds will be made according to the Tuition & Fees Refund Schedule. TUITION & FEES REFUND SCHEDULE The school shall, when a student gives written notice of cancellation or withdrawal, the student may be eligible for a tuition and fee refund based on the following: 1. When notice of cancellation is given before midnight of the 5 th business day after the date of enrollment but prior to the 1 st day of class, all payments made, except for registration fee and completed miscellaneous expense shall be refunded to the student; 4

5 2. When notice of cancellation is given after midnight of the 5 th business day following acceptance but prior to the close of business on the student's 1 st day of class attendance, the school may retain no more than the registration fee and completed miscellaneous expense which may not exceed $150 or 10% of the cost of tuition, whichever is less; 3. When notice of cancellation is given after the student's completion of the 1 st day of class attendance, but prior to the student's completion of 5% of the course of instruction, the school may retain the registration fee, completed miscellaneous expense, an amount not to exceed 10% of the tuition and other instructional charges or $300, whichever is less, the cost of any books or materials which have been provided by the school. 4. When notice of cancellation is given after the student's completion of 5% of the course of instruction, the school may retain an amount computed pro rata by days in class plus 10% of tuition and other instructional charges up to completion of 60% of the course of instruction. 5. When the student has completed in excess of 60% of the course of instruction, the school may retain the registration fee and the entire tuition and other charges. 6. A student who on personal initiative and without solicitation enrolls, starts and completes a course of instruction before midnight of the 5 th business day after the enrollment agreement is signed, is not subject to the cancellation provisions of this refund policy. 7. Deposits or down payments shall become part of the tuition. Provided is a tabulated version of the Tuition & Fees Refund Schedule, as of March 30, 2014 until otherwise revised. Receipt of Notice Before midnight of the 5 th business day from enrollment After midnight of the 5 th business from enrollment but before close of business on the 1 st day of attendance After completion of 1 st day of attendance but prior to 5% completion of course 5% completion: 1.5 days or 6 hours 5% - 60% completion of course 60% completion: 18 days or 72 hours Excess of 60% completion of course: Student on personal initiative and without solicitation enrolls, starts and completes a course of instruction before midnight of the 5th business day after enrollment agreement is signed Applicant not accepted by the school Refund Full Refund of the tuition fee, except for registration fee Retain no more than the registration fees and other miscellaneous fees; not exceeding $150 or 10% of cost of tuition whichever is less LMSTC: $50 Registration Fee $10 Background Check paperwork $10 Gait Belt (may be returned if unused) $10 Stethoscope (may be returned if unused) $70 Cost of Book (may be returned if unused) Total $75.00 (max) Retain registration fee, 10% of tuition and other miscellaneous fees or $300 whichever is less LMSTC: $50 Registration Fee $10 Background Check paperwork $10 Gait Belt (may be returned if unused) $10 Stethoscope (may be returned if unused) $70 Cost of Book (may be returned if unused) $75 (10% of tuition) Total - $ (max) Retain registration fee, amount computed pro rata by days in class plus 10% of tuition and other miscellaneous fees LMSTC: $50 Registration Fee $10 Background Check paperwork $10 Gait Belt (may be returned if unused) $10 Stethoscope (may be returned if unused) $70 Cost of Book (may be returned if unused) $35 Cardiopulmonary Resuscitation Training $25 per 4-hr day times no. of days attended Total $635 (max) Retain all Not subject to the cancellation provisions Receive refund of all tuition fees within 30 calendar days after the determination of non-acceptance 5

6 STUDENT S RIGHT TO CANCEL The student has the right to cancel the initial enrollment agreement until midnight of the 5 th business day after the student has been admitted. If the right to cancel is not given to any prospective student at the time the agreement is signed, then the student has the right to cancel the agreement at any time and receive a refund on all monies paid to date within 10 days of cancellation. Cancellation should be submitted to the authorized official of the school in writing. CANCELLATION/WITHDRAWAL POLICY The student who wishes to cancel or withdraw enrollment may give notice of cancellation to the school in writing. If no notification is received, and a student has had an unexplained absence of more than 5 consecutive days, the school shall consider the student to have withdrawn from the program. In all cases, the date of withdrawal shall be the last day of attendance. Refunds shall be made within 30 days of the last day of the attendance if written notification has been provided to the institution by the student; otherwise, refunds shall be made within 30 days from the date the institution terminates or determines that the student has withdrawn. Determination that a student has withdrawn shall be made within 15 days of the last day of attendance. The school shall provide written acknowledgement of a student s notification of withdrawal within 15 calendar days of the postmarked date of the notification of withdrawal. In all instances, refunds shall be based on and computed from the last day of attendance. CANCELLATION/WITHDRAWAL PROCEDURE Withdrawing from the school may have both academic and financial consequences. Students are encouraged to understand the consequences before you decide to withdraw. Detailed information from the cancellation and withdrawal from the school is available. If student decides to withdraw, student must follow the established procedures. If a student is enrolled in program and/or paid fees, and do not plan on attending the class, student must take action by doing one of the following otherwise, the student will be billed for that course fees and/or receive failing grades: Cancelling Registration before instruction for the applicable term begins Withdrawing from a program/course in progress Notification Deadline / Timing Impact on Academic Records What will be refunded Cancellation In writing to office of the Program Coordinator/Chief Managing Employee Must be done before the 1 st day of instruction for the applicable term. Will not affect your transcript. 100% of the assessed fees excluding registration Withdrawal In writing to the office of the Program Coordinator/Chief Managing Employee Any time after the 1 st day of instruction for the term and before the end of the term. Your transcript will not reflect any coursework but will indicate a withdrawal. The percentage of the refund depends on the effective date of withdrawal. Please see Tuition & Fees Refund Schedule. 6

7 Cancelling Registration Before Instruction Begins If student do not wish to attend classes and instruction has not yet begun, student must formally request a cancellation of student s registration from the School. When student cancels, any classes in which student are enrolled will be dropped from student s schedule and student will not be able to attend any future classes until student is readmitted. Cancellation of registration can be done by notifying the Office Program Coordinator/Chief Managing Employee in writing prior to the first day of instruction for the class, by either sending your notification to the Office Program Coordinator/Chief Managing Employee, 6912 Main Street, Ste. 110-B, Downers Grove, IL 60516, or ing Student refund will be based on the Tuition & Fees Refund Schedule. There will be no notation of the cancellation on student s transcript. Withdrawing from a Program/Class in Progress Once instruction for the program/class has begun, student cannot cancel registration. The student must withdraw. When student withdraws, any classes in which student are enrolled will be dropped from student s schedule, and student will no longer be eligible to attend for those classes or any future classes until student is readmitted. Student must withdraw through the school s Program Coordinator/Chief Managing Employee office. Student refund will be based on the Tuition & Fees Refund Schedule. Transcript will not reflect any course work, but will indicate a withdrawal for the applicable term. Notice to Admitted Students New student(s) who would like to defer admission to another term, must contact the Admissions Office. If you wish to cancel or withdraw, please contact your Program Coordinator/Chief Managing Employee before canceling or withdrawing. If student cancels registration, student will be required to submit a new admission application to attend future classes. Fee Adjustments for Withdrawals Fee adjustments, if any, are based on the student s withdrawal date. All fee adjustments for withdrawals are applied to the students account and may be applied to any outstanding debts. Registration fee is not refundable. If the student withdraws, it is imperative that student update his/her address(es) with the Accounting Office to ensure student will receive all notices of fee adjustments. The final day for a student to withdraw from any course will be equal to 60% of the time for the respective academic session. Check with the Admissions Office. After the deadline, students will be required to appeal for late withdrawal and provide appropriate documentation to the Admissions Office for all requests. Students who are granted approval to withdraw by petition will not be eligible for refunds of tuition or fees and will receive a W grade on their transcript. Appeals must be submitted prior to the designated final exam period for 5-week classes and before the last class meeting for all other classes. 7

8 NOTICE TO STUDENT 1. Do not sign this agreement before you have read it or if it contains any blank spaces. 2. This agreement is a legally binding instrument and is only binding when the agreement is accepted, signed, and dated by the authorized official of the school or the admissions officer at the school s administrator s place of business. Read all pages of this contract before signing. 3. You are entitled to an exact copy of the agreement and any disclosure pages you sign. 4. This agreement and the school catalog constitute the entire agreement between the student and the school. 5. Any changes in this agreement must be made in writing and shall not be binding on either the student or the school unless such changes have been approved in writing by the authorized official of the school and by the student or the student s parent or guardian. All terms and conditions of the agreement are not subject to amendment or modification by oral agreement. 6. The school does not guarantee the transferability of credits to another school, college, or university. Credits or coursework are not likely to transfer; any decision on the comparability, appropriateness and applicability of credit and whether credit should be accepted is the decision of the receiving institution. The school recommends that the students must consult with the institutions to which they may seek to transfer. 7. I understand that should I withdraw from a program or course prior to the completion of said program or course, I am responsible for returning all property including textbooks, when applicable. Cost of books and materials refundable if returned in good condition. 8. Under the law you have the right, among other, to pay the full amount due and to obtain under certain conditions a partial refund of the finance charge. STUDENT COMPLAINT POLICY The School shall resolve student complaints promptly and fairly and shall not subject a student to punitive action because of written grievances having been filed with the school or the IBHE. The student has the right to voice grievances regarding grades, records, facility, or other concerns, by anyone who is providing services on behalf of the School and must not be subjected to discrimination or reprisal for doing so. The School however recommends that student must first discuss with the concerned instructor, or school employee to resolve any concern/complaint/grievance. If student s complaint/grievance is unresolved, student may submit in writing to the Program Coordinator/Chief managing Employee of LarLin Medical Staffing & Training Center, Inc. to the following address: LarLin Medical Staffing & Training Center, Inc Main Street, Ste. 110-B Downers Grove, IL (630) / (630) (Fax) The school must investigate complaints/grievances filed by students or the student s family regarding services that is or fails to be provided, or whatever concern against anyone who is providing services on behalf of the School, and must document both the existence of the complaint and the resolution of the complaint. Students will be informed of their right to complain or present grievances according to the School s policy. The school assures the student/student s family that any complaint will be addressed by the school staff within 48 hours. The school shall maintain a written record of its handling of all student complaints. 8

9 If student s complaint/grievance remains unresolved or if student is not satisfied with the outcome of the investigation process may submit in writing to the program director of Illinois Board of Higher Education to the following address: Illinois Board of Higher Education Private Business and Vocational School 431 East Adam St, 2nd Floor Springfield, IL (217) / (217) (fax) STUDENT ACKNOWLEDGMENTS 1. I hereby acknowledge receipt of the school s catalog, which contains information describing programs offered, and equipment or supplies provided. The school catalog is included as part of this enrollment agreement and I acknowledge that I have received a copy of this catalog. 2. I have carefully read and received an exact copy of this enrollment agreement. 3. I understand that the school may terminate my enrollment if I fail to comply with attendance, academic, and financial requirements or if I fail to abide by established standards of conduct, as outlined in the school catalog. While enrolled in the school, I understand that I must maintain satisfactory academic progress as described in the school catalog and that my financial obligation to the school must be paid in full before a certificate or credential may be awarded. 4. I hereby acknowledge that the school has made available to me all required disclosure information listed under the Consumer Information section of this Enrollment Agreement. 5. I understand that the school does not guarantee transferability of credit and that in most cases, credits or coursework are not likely to transfer to another institution. In cases where transferability is guaranteed, LarLin Medical Staffing & Training Center must provide me copies of transfer agreements that name the exact institution(s) and include agreement details and limitations. 6. I understand that the school does not guarantee job placement to graduates upon program completion. 7. I understand that complaints, which cannot be resolved by direct negotiation with the school in accordance to its written grievance policy, may be filed with the Illinois Board of Higher Education, 431 East Adams Street, 2 nd Floor, Springfield, IL or at 9

10 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 Coordinator s Signature Date 10

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