"*" indicates required fields Step 1 of 4 25% ENROLLMENT AGREEMENT CNA Training & Testing Center 808B Oakfield Dr Brandon, FL 33511 E: firstname.lastname@example.org P: (813) 955-4237Student InformationFirst Name* Last Name* Gender* Male Female Date of Birth* Month Day Year SSN* Contact InformationCell Phone Number*Home Phone NumberHome Phone NumberAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* High School Certification***High School Diploma or GED is Not Required***I CERTIFY that I am a high school graduate or have successfully obtained a high school diploma equivalency diploma (GED).Student Initials (If you have not graduated or obtained a GED, do not initial).Payment TermsEnrollment fee includes one set of scrubs and a manual. Full payment of tuition is due on the first day of class. Financial Aid is not available. Student Initials* HiddenAge What Month Are You Starting?What Month Are You Starting?-- Choose the month you are starting --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberCareer Services Ongoing job placement assistance will be provided to all graduates without additional charge. No guarantee of placement and/or employment directly or indirectly is implied. Records of all graduates are maintained permanently. Cancellation and Refund Policy Cancellation must be made in person, by electronic email, or by certified mail. All monies will be refunded if the school does not accept the applicant or if the student cancels within three (3) business days after signing the Enrollment Agreement and making initial payment. Cancellation after the third (3rd) business day but before the first class will result in a refund of all monies paid with the exception of the registration fee (Not to exceed $150.00). Cancellation after attendance has begun, through 40% completion of the program will result in a Pro Rata refund computed on the number of hours completed to the total program hours. Cancellation after completing more than 40% of the program will result in no refund. Termination Date: The termination date for refund computation purposes is the last date of actual attendance by the student. Refunds will be made within 30 days of termination or receipt of Refund Request Notification. A student can be dismissed, at the discretion of the Administrator, for insufficient progress, non-payment of costs, disruption of class or failure to comply with the rules. Classes may be rescheduled or cancelled at the discretion of the Administrator. If classes are cancelled, a full refund will be issued. All registrants will be notified in advance should this occur. Program Cancellation Policy CNA Training & Testing Center and its Career Training Institute reserve the right to determine that program or course postponement, cancellation, or facility closure is in its best interest. Affected students shall be notified, as follows: Program or Course Postponement Be by telephone, email or text (as appropriate). Contain an anticipated date that the program or class is scheduled to resume. Contain a provision for the student to delay his or her attendance or receive a refund of tuition and appropriate fees. The refund shall be paid within 30 days of receipt of the student’s written request for a refund. Students who choose to delay their attendance shall be provided additional notification by telephone and e-mail (as appropriate) of the date that the program or course is to resume when that date has been finalized. Program or Course Cancellation Be by telephone and email (as appropriate). Contain a provision for the student to receive a full refund of tuition for that course and/or program and appropriate fee. The refund shall be paid within 30 days of receipt of the student’s written request for a refund. Temporary Closure of a Facility Student notification of temporary closure of a facility shall be by telephone, email (as appropriate) and the USPS, contain an anticipated date that the facility is scheduled to reopen and contain a provision for the student to delay his or her attendance or receive a refund of tuition and appropriate fees. The refund shall be paid within 30 days of receipt of the student’s written request for a refund. Additionally, in the event of temporary facility closure the institution shall post a notice on all facility entrances. The notice(s) shall contain an explanation of circumstances surrounding temporary closure, an anticipated date that the facility is scheduled to reopen, the name and contact information for the school’s president or representative and CIE’s contact information. Student Initials* Graduation Requirements: I understand that in order to graduate from the program and receive a diploma, I must successfully complete the required number of scheduled clock hours as specified in the catalog. I understand that this is a legally binding contract. My signature below certifies that I have received and read a copy of the current catalog, the provisions of which I accept. I have read and understood all provisions of this agreement, and I have been given a copy of it for my records.Student Signature*Parent Signature(if under the age of 18)Date MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.