EmailMe Form - 1st Choice CC Allied Health Training

Date of Application/Enrollment (Format 03/19/1975) *

Student Name *

First Last

Social Security Number *

### - ### - ####

Date of Birth
(Format 03/19/1975) *

Home Phone

### - ### - ####

Cell Phone

### - ### - ####

Email *

Confirm

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Upload two (2) forms of ID:
(Please Take Clear Picture of IDs Together then Upload) State ID/Drivers License and SS Card/Birth Certificate are accepted IDs *

U.S Citizen *

Yes

No

Re-entry Student *

Yes

No

Student Personal Schedule

In case of emergency notify *

First Last

Phone Number *

### - ### - ####

Are you at least 16 years or older?

Yes

No

Have you been convicted of a Felony? If so, please describe below & call us before payment is submitted. *

Yes

No

Paragraph Text

Education History:
List Name of School/Address/Course Study/Graduation Date

I hereby enrolling in the following academic program and my enrollment is subject to the terms and conditions stated in the enrollment agreement. *

HHA (2-Week, 75 Hour Training Tuition $225)

STNA/CNA Daytime (2-Week, 76 Hour Training Tuition $475)

STNA/CNA Evening (3-Week, 76 Hour Training Tuition $475)

Phlebotomy Technician (6-Week, 56 Hour Training Tuition $675)

EKG Technician (6-Week, 56 Hour Training Tuition $625)

CPR/First Aide Class ($45 for 1 Certification $75 for Both Certification)

Medication Administration Course (14-Hour Training Tuition $150)

Medication Administration Renewal Course (2-Hour Training Tuition $65)

Don't see the class you interested in? Please provide course

How did you hear about us?

Payment:

All tuition and fees are payable for one school term only. Registration payment is due prior to the start of class. Payments can be arranged with the director, but all payments/tuition must be paid in full by the end of class. 1st Choice Career Centers will enroll each student under 1st Choice liability insurance policy, which is included into the tuition and fees. Additional cost for health physicals, assessments, and/or immunizations may apply and is the responsibility of the student.

Total projected cost of program at current tuition and fee rates: (Listed Above)

Tuition and fee charges are subject to change at the school discretion. Any tuition or fee increases will become effective for the school term following student notification of the increase.

Cancellation and Settlement policy:

This enrollment agreement may be canceled within five calendar days after the date of signing provided that the school is notified of the cancellation in writing. If such cancellation is made, the school will promptly refund in full all tuition and fees paid pursuant to the enrollment agreement and the refund shall be made no later than thirty days after cancellation. This provision shall not apply if the student has already started academic classes.

Refund Policy

If the student is not accepted into the training program, all monies paid by the student shall be refunded. Refunds for books, supplies and consumable fees shall be made in accordance with Ohio Administrative Code section 3332-1-10.1. There is one (1) academic term for this program that is 68 clock hours in length. Refunds for tuition and refundable fees shall be made in accordance with following provisions as established by Ohio Administrative Code section 3332-1-10:

Refund policy for students who voluntarily withdraw and who are dismissed from their course.

• A full refund will be given of all monies paid if the school cancels the class as noted on the school calendar.

• If a student starts a class and withdraws or is terminated from the course before the academic term is fifteen per cent complete will be obligated for twenty-five per cent of the tuition and refundable fees plus the registration fee.

• A student who starts class and withdraws or is terminated from the course after the academic term is fifteen per cent complete but before the academic term is twenty-five per cent complete will be obligated for fifty per cent of the tuition and refundable fees plus the registration fee.

• A student who starts class and withdraws or is terminated from the course after the academic term is twenty-five per cent complete but before the academic term is forty per cent complete will be obligated for seventy-five per cent of the tuition and refundable fees plus the registration fee.

• A student who starts class and officially withdraws or is terminated from the course after the academic term is forty per cent complete will not be entitled to a refund of the tuition and fees

• Nonattendance is not a reason for a refund.

• It is the responsibility of the student to view the posted online deadlines and schedules, and withdraw during the appropriate time for a refund.

• If the class is cancelled by the intuition due to low enrollment or other reasons the student will be granted a 100% refund or may take the next available class. Refund for this
situation only will be resubmitted back to credit/debit card used or student will be issued a refund check within 7 days of cancellation.

• Refunds will be submitted within 45 days of voluntary withdrawal or dismissal.

The school shall make the appropriate refund within 45 (forty-five) of the date the school is able to determine that a student has withdrawn or has been terminated from a program. Refunds shall be based upon the last date of a student’s attendance or participation in an academic school activity.

Complaint or Grievance Procedure

All student complaints should be first directed to the school personnel involved. If no resolution is forthcoming, a written complaint shall be submitted to the director of the school. Whether or not the problem or complaint has been resolved to his/her satisfaction by the school, the student may direct any problem or complaint to the Executive Director, State Board of Career Colleges and Schools, 30 East Broad Street, Suite 2481, Columbus, Ohio, 43215, Phone 614-466-2752; toll free 877-275-4219.

I have read, understand, and agree to comply with 1st Choice Career Centers Tuition Withdrawal and Refund Policy that has been clearly explained to me.

I acknowledge that I have received a school catalog (listed on the school website) and agree with the school policies and procedures stated. I acknowledge that I have received and read a copy of this enrollment agreement.

If you agree with this enrollment agreement, terms the refund policy please type in I agree, your name, and today's date. Please NOTE your typed name act as your signature for
this agreement: *

Are you aware you are not enrolled until your payment is received? *

Yes

No

I also understand this is a (see below) hour course with (see below)hours of clinical. After successful completion of this program, you will be eligible for the NHA (National Health Career Exam) to obtain your credentials for Phlebotomy/EKG and eligible to take the NATP exam for ODH (Ohio Department of Health) to obtain your credentials for STNA. *

CNA/STNA (59 Classroom Hours and 16 Clinical Hours)

Phlebotomy (56 Classroom and Skills Hours)

EKG (56 Classroom and Skills Hours)