STUDENT ENROLLMENT AGREEMENT PACKET...2016/05/13 · certificate you receive at the end of the STNA...

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STUDENT ENROLLMENT AGREEMENT PACKET

Table of Contents:

Welcome ......................................................................................................................................... 2

What is a Nursing Assistant? ......................................................................................................... 2

About Us ......................................................................................................................................... 3

Our Contact Information ................................................................................................................ 3

Business Hours of Operation .......................................................................................................... 3

Important Student Enrollment Information .................................................................................... 4

Program Registration * ................................................................................................................... 5

Payment Information * ................................................................................................................... 6

Program Eligibility ......................................................................................................................... 7

Clinical Information ....................................................................................................................... 7

Enrollment Policy ........................................................................................................................... 8

Payment Policy ............................................................................................................................... 8

Program Eligibility ......................................................................................................................... 8

Code of Conduct ............................................................................................................................. 8

Student Grievance/Resolution Procedures ..................................................................................... 8

Disability Services .......................................................................................................................... 9

Attendance Policy ........................................................................................................................... 9

General Policies .............................................................................................................................. 9

Signature Page 1 * ........................................................................................................................ 11

Signature Page 2 * ........................................................................................................................ 12

* pages retained at New Beginnings NATP for student records

STUDENT ENROLLMENT AGREEMENT

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Welcome

Congratulations!

You have decided to join one of the fastest growing healthcare careers through our nursing assistant

program. If you are a caring individual who enjoys helping people, then the STNA position is for you. Nursing

assistants work in a variety of healthcare settings to improve their patients’ wellbeing by assisting them with

their personal care and monitoring progress with their recovery goals. Nursing assistants work as Care Partners,

Patient Care Assistants, Caregivers, Clinical Assistants, Patient Care Technicians (PCTs), Home Health Aides,

Resident Assistants, and more. As a member of the healthcare team, nursing assistants are the frontline staff

because they have the most direct care with the patients.

You will be training for this in-demand health career through our state-approved, 75-hour training

program. The clinical experience prepares you for employment in long-term care facilities, hospitals, clinics,

and home-health agencies. Upon completion of your training, you will be eligible to take the state competency

exam. As an STNA your career outlook is excellent. This profession is expected to grow at an extremely rapid

rate. We are excited about your career choice and about choosing New Beginnings NATP to help you become a

STNA. GOOD LUCK!

What is a Nursing Assistant?

A nursing assistant (or nurse aide) assists individuals with healthcare needs and ADL (activities of daily

living). They also provide bedside care and basic nursing procedures under supervision of an RN (registered

nurse) or LPN (licensed practical nurse).

CNA (certified nursing assistant) is the previous term that was used to describe someone who had passed the

state nurse aide exam. The term has since been replaced by STNA. The term CNA has since, inaccurately, been

adopted to refer to a person who has successfully completed a state approved curriculum course and received

their Certificate of Completion of the Nurse Aide Training and Competency Evaluation Program (which is the

certificate you receive at the end of the STNA class) but have not yet taken their state test. The certificate of

completion is the documentation needed to prove that the course has been successfully completed, thus

providing eligibility to take the state test.

STNAs (State Tested Nursing assistants) are individuals who have successfully completed the STNA course

(having received their certificate) and then successfully passed the state test, which allows them to be listed on

the Ohio State Nurse Aide Registry. Becoming a STNA is an important step for those with a goal of becoming

an LPN or RN.


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About Us

New Beginnings NATP is a vocational school that uses a curriculum and training program approved by the

Ohio Department of Health to provide the skills necessary to become a nursing assistant. During training,

aspiring nursing assistants will receive the information and tools necessary for safe, effective, and respectful

care as outlined by the training requirements by the Omnibus Budget Reconciliation Act of 1987. Graduates of

the course will receive a Certificate of Completion of the Nurse Aide Training and Competency Evaluation

Program (NATCEP) and are then eligible to take the state test to become an STNA. We proudly serve Dayton,

Montgomery County, and the surrounding areas.

Additionally we are a state nurse aide exam testing site. Being a test site allows for New Beginnings alumni to

test in a familiar environment, as well as a convenient testing location for local graduates from other Dayton

area STNA programs and even graduates from anywhere in the state of Ohio.

Our Contact Information

New Beginnings Nursing Aide Training Program, LLC

2580 Shiloh Springs Road, Suite E

Trotwood, Ohio 45426

937-837-6287

937-867-1703 (fax)

[email protected]

Like us on Facebook at

www.facebook.com/NewBeginningsNATP

Office Hours of Operation

Monday: 9:00 am - 5:00 pm

Tuesday: 9:00 am - 5:00 pm

Wednesday: 9:00 am - 5:00 pm

Thursday: 9:00 am - 5:00 pm

Friday: 9:00 am - 3:00 pm

Saturday: Closed

Sunday: Closed


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Important Student Enrollment Information Reminders

Class Start Date:______/______/______

Class Session:

___8:00 am - 4:00 pm “Day Class” (2 ½ week course)

___8:00 am - 12:00 pm “Morning Class” (4 week course)

___1:00 pm - 5:00 pm “Afternoon Class” (4 week course)

___6:00 pm - 10:00 pm “Evening Class” (4 week course)

STUDENT CHECKLIST: (DETAILED INFORMATION ON PAGE 7)

___ 2-STEP MANTOUX TB TEST (AVAILABLE AT THE COMBINED HEALTH DISTRICT IN THE REIBOLD BLDG.

ON 4TH

ST.)

___ BCI BACKGROUND CHECK (AVAILABLE AT BMV IN TROTWOOD, ENGLEWOOD, OR HUBER HEIGHTS)

___ A SET OF SCRUBS (ANY COLOR) FOR YOUR CLINICALS (NO CARTOON CHARACTERS ALLOWED)

TESTING CONSULTATION APPOINTMENT ______/______/______, ______:______ AM / PM

Payment Information

Payment Policy: The tuition for the STNA course must be paid in full no later than 3 business days before the 1st day of

class. All payments are non-refundable unless otherwise specified. Payment plans are available, and there is a $10 fee to

utilize this option. The initial payment at the time of enrollment must be at least $100. Any missed payments or failure to

have a $0 balance by the date indicated on this form will result in the loss of your seat in the class and forfeiture of all

other funds paid to New Beginnings NATP. In the event that you choose to cancel your registration for the class, it must

be done no later than 2 weeks prior to the class start date for you to receive a refund minus the $100 administration fee.

Failure to comply will result in losing all funds paid, but you will have the option of transferring into any available class

offered within 90 days from the start date of the class you were originally registered for. The deadline for transferring into

another class is 3 business days prior to the class start date. You are responsible for ensuring your enrollment as a transfer

within the 90-day transfer period. If you choose not to transfer or if your transfer period expires, you will not be refunded

any money paid. *Please note that the state testing fee is not included in your STNA class registration/enrollment fees.

Method of Payment:

$_________FULL TUITION at time of registration ----------------------------- This tuition price is: Standard pricing

$10.00 Payment Plan Service Fee Promotional pricing

$28.50 Textbook

$100.00 State Testing

______.____ ( ______% card processing fee)

$_________.______ GRAND TOTAL

*please check all that apply:

Cash Money Order Business Check Debit/Credit (processing fees will apply: 2.78% - 3.78%)

*ONLY fill in section below if utilizing payment plan

Initial payment amount: $_________.______ (must be a minimum of $100)

Last day to complete payment plan:______/______/______ (last day of registration)

Date Amount Balance

$0.00


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Program Registration

Name: First Name Middle Initial Last Name

Social Security Number: - - Date of Birth: / /

SEX: MALE FEMALE E-mail:

Mailing Address:

Street Address Apt./Ste. City State Zip code

Home Phone: ( ) - Cell Phone: ( ) -

How did you hear about us?

Emergency Contact:

Name:_____________________________________ Phone number: (_________) _________-____________

Relationship to student:_____________________________

Name:_____________________________________ Phone number: (_________) _________-____________

Relationship to student:_____________________________

Enrollment Policy: You must be at least 16 years of age or older to participate in this program. We have a

minimum number of students that we must reach monthly in order to hold classes. We reserve the right to

cancel the class if that number is not met. You will be contacted as soon as possible if the class will not be held.

All money will be refunded.

I verify that all of the above information is current and accurate to the best of my knowledge. I

acknowledge that any misrepresentation of the above information could result in disqualification or

dismissal from the program and that any funds paid to the school would be forfeited.

Signature:___________________________________________ Date:______/______/______

*SECTION BELOW TO BE FILLED IN BY OFFICE STAFF

Class Information:

Class Start Date:______/______/______

Class Session: (please check one)

___8:00 am - 4:00 pm “Day Class” (2 ½ week course)

___8:00 am - 12:00 pm “Morning Class” (4 week course)

___1:00 pm - 5:00 pm “Afternoon Class” (4 week course)

___6:00 pm - 10:00 pm “Evening Class” (4 week course)

Class Instructor:___________________________

TESTING CONSULTATION APPOINTMENT ______/______/______, ______:______ AM / PM


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Payment Information

Payment Policy: The tuition for the STNA course must be paid in full no later than 3 business days before the

1st day of class. All payments are non-refundable unless otherwise specified. Payment plans are available, and

there is a $10 fee to utilize this option. The initial payment at the time of enrollment must be at least $100. Any

missed payments or failure to have a $0 balance by the date indicated on this form will result in the loss of your

seat in the class and forfeiture of all other funds paid to New Beginnings NATP. In the event that you choose to

cancel your registration for the class, it must be done no later than 2 weeks prior to the class start date for you to

receive a refund minus the $100 administration fee. Failure to comply will result in losing all funds paid, but

you will have the option of transferring into any available class offered within 90 days from the start date of the

class you were originally registered for. The deadline for transferring into another class is 3 business days prior

to the class start date. You are responsible for ensuring your enrollment as a transfer within the 90-day transfer

period. If you choose not to transfer or if your transfer period expires, you will not be refunded any money

paid. *Please note that the state testing fee is not included in your STNA class registration/enrollment fees.

Method of Payment:

$_________FULL TUITION at time of registration ------------------ This tuition price is: Standard pricing

$10.00 Payment Plan Service Fee Promotional pricing

$28.50 Textbook

$100.00 State Testing

______.____ ( ______% card processing fee)

$_________.______ GRAND TOTAL

*please check all that apply:

Cash Money Order Business Check Debit/Credit (processing fees will apply: 2.78% - 3.78%)

*ONLY fill in section below if utilizing payment plan

Initial payment amount: $_________.______ (must be a minimum of $100)

Last day to complete payment plan:______/______/______ (last day of registration)

Date Amount Balance

$0.00

I have read and agree to the terms and conditions of the payment policy. I agree to adhere to the

payment plan and make all payments as outlined in the payment schedule.

Signature:___________________________________________ Date:______/______/______


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Program Eligibility

All students are required to complete a BCI background check and 2-step Mantoux TB test to be eligible to

attend clinicals. Proof of the BCI Background check and completion of the 1st step of a 2-step Mantoux TB test

are to be turned in by the end of the 1st week of class. The 2nd step of a 2-step Mantoux TB test is due by the

end of the 2nd week of class. Failure to comply will result in the student being unable to participate in clinicals

and disqualification from graduating.

Clinical Information

Site: Cross Roads Nursing and Rehabilitation

208 N. Cassel Rd

Vandalia, OH 45377

(937) 898-4202

Time: 7:00am – 3:30pm (please arrive on time)

Cell phone use is not permitted.

Policies may vary depending on the clinical site. Be advised that we will defer to the policies of each site.

Dress Code:

Scrubs (no cartoon characters)

No open toed/open heeled shoes, dress shoes or casual shoes. No Croc-type shoes. Wear ONLY

washable/wipe-able gym shoes or nursing shoes.

Name badges are to be worn on the upper left chest and visible at all times in the clinical setting.

Tattoos covered

Long hair pinned up

No hats

No visible body piercings. All jewelry must be removed from face, tongue, and any areas that are

visible.

Only small stud-like or small hoop earrings

Remember residents of all facilities may be confused and/or disoriented and may attempt to grab at

shiny objects or any objects within their reach.

Necklaces contained (only one or none)

No sharp rings on fingers (only wedding band or engagement ring)

Fingernails are not allowed to be longer than .25 (1/4) inches beyond the fingertip. No artificial/acrylic

nails.


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Enrollment Policy

You must be at least 16 years of age or older to participate in this program. We have a minimum number of students

that we must reach monthly in order to hold classes. We reserve the right to cancel the class if that number is not

met. You will be contacted as soon as possible if the class will not be held. All money will be refunded.

Payment Policy

The tuition for the STNA course must be paid in full no later than 3 business days before the 1st day of class. All

payments are non-refundable unless otherwise specified. Payment plans are available, and there is a $10 fee to

utilize this option. The initial payment at the time of enrollment must be at least $100. Any missed payments or

failure to have a $0 balance by the date indicated on this form will result in the loss of your seat in the class and

forfeiture of all other funds paid to New Beginnings NATP. In the event that you choose to cancel your registration

for the class, it must be done no later than 2 weeks prior to the class start date for you to receive a refund minus the

$100 administration fee. Failure to comply will result in losing all funds paid, but you will have the option of

transferring into any available class offered within 90 days from the start date of the class you were originally

registered for. The deadline for transferring into another class is 3 business days prior to the class start date. You are

responsible for ensuring your enrollment as a transfer within the 90-day transfer period. If you choose not to transfer

or if your transfer period expires, you will not be refunded any money paid. *Please note that the state testing fee is

not included in your STNA class registration/enrollment fees.

Program Eligibility

All students are required to complete a BCI background check and 2-step Mantoux TB test to be eligible to attend

clinicals. Proof of the BCI Background check and completion of the 1st step of a 2-step Mantoux TB test are to be

turned in by the end of the 1st week of class. The 2nd step of a 2-step Mantoux TB test is due by the end of the 2nd

week of class. Failure to comply will result in the student being unable to participate in clinicals and disqualification

from graduating.

Code of Conduct

Students may be removed from the class, lab, or clinical experience for unsafe, unethical, or inappropriate

behavior. If this occurs, the student/trainee may be dismissed from the program and will not be entitled to a

refund. Examples of such behaviors are: being under the influence of drugs and/or alcohol, stealing, cheating,

falsification and/or alteration of any documents submitted to New Beginnings NATP, endangering others, use

of profanity or inappropriate language, talking loudly or at inappropriate times, or interruption of class or

clinicals by cell phone use or text messaging. These are just examples and are not all-inclusive.

Please display professionalism at all times. Unprofessional attitudes and behaviors will not be tolerated. You are

expected to always be professional to all those you encounter. Failure to do so may result in disciplinary action

up to and including expulsion from the program. Students who are expelled will not receive a refund.

Student Grievance/Resolution Procedure

In attempting to resolve any student concerns, grievance regarding grades, evaluations, or other fulfillments of

the academic responsibility, it is the obligation of the student to first make a serious effort to resolve the matter

with the instructor. Individual faculty members retain primary responsibility for assigning grades and

evaluations.


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Disability Services

The goal of Disability Services is to provide students with disabilities equal educational opportunities.

Disability services provide students with a documented letter to present to the faculty member to verify that the

student has a disability and needs accommodations. This letter should be presented to the instructor at the

beginning of the class and accommodations needed should be discussed at that time. If you do not have any

such documentation but feel that this may apply to you, please consult your physician.

Attendance Policy

The State of Ohio requires 100% attendance for the NATCEP/STNA training program according to the Ohio

Administrative Code paragraph D of rule 3701-18-08. No student shall miss more than 16 hours of class, all of

which must be made up. All missed time must be made up within 60 days from the date missed. Arrangements for

makeup time will be at the discretion of the instructor. Failure to attend any makeup session(s) may result in

dismissal from the program. Any student who misses more than 16 hours of class time will automatically be

withdrawn from the class. Students who are automatically withdrawn or students who withdraw voluntarily (within

the first 28 course-hours) will have the one time option to roll over their tuition to restart in an upcoming class

session within 60 days from their session end date. Students who do not choose to roll over their tuition will forfeit

all moneys paid. For unexcused missed clinical time students will need to attend the next scheduled clinical session

within 60 days of their missed time, provided that there is space in the group (on a first come first served basis). If

there is no open space available in the group, or an additional instructor must be brought in to accommodate the

extra student(s), or an unscheduled clinical session(s) must be created to accommodate the student’s 60-day window

for makeup time, there will automatically be a $50 fee per student and per session, which will be due prior to

attending clinicals. Please note that failure to have TB tests, background checks, or scrubs in time for clinicals

will be considered an unexcused absence. Additionally, illness will not be excused without a doctor’s note

(potentially including leaving early or being sent home due to illness), and attending a funeral will not be excused

without a funeral program.

Any student who is late more than 15 minutes (at the 16th minute) will not be permitted into class that day and will

be considered absent (and will have to make that time up). Additionally, any student who is more than 15 minutes

late returning from lunch/class breaks will not be permitted back into class that day. All late time (including 1-15

minutes) must be made up within 60 days of the date missed.

Students withdrawn from the program due to attendance will not receive a refund.

General Policies

There will not be any money refunded for programs not completed.

You must receive a comprehensive grade of 80% or higher to pass the course.

Use of cell phones is not permitted in the classroom or at the clinical location. Failure to comply may

result in disciplinary action.

No guests (children, friends, parents, etc.) are allowed in the class or clinicals.

You may wear casual apparel in the classroom.

You are solely responsible for your personal belongings. We are not accountable for any items that are

lost, damaged, or stolen.


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-- PAGE INTENTIONALLY BLANK --


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Signature Page (1 of 2)

Waiver of Liability

I, ______________________________, am voluntarily participating in the New Beginnings Nurse Aide

Training Program. In consideration of the risk of injury while participating in Nurse Aide Training (henceforth

referred to as “the activity"), and as consideration for the right to participate in the activity, I agree to indemnify

and hold harmless New Beginnings NATP and its partnering Clinical and Non clinical Contract

Facilities/Companies against any and all claims, suits, or cause of actions of any kind whatsoever for liability,

damages, compensation, or otherwise brought by me or anyone on my behalf arising as a result of my

participation in the New Beginnings Nurse Aide Training Program.

Signature:___________________________________________ Date:______/______/______

Verification of Health Status:

I hereby affirm that to the best of my knowledge I am healthy and am able to work in a long term care facility

caring for elderly and disabled residents and do not have any restrictions nor any communicable illness.

Signature:___________________________________________ Date:______/______/______

I have received a copy of all of the following policies and procedures (PLEASE INITIAL NEXT TO EACH ONE):

______Enrollment Policy

______Payment Policy

______ Program Eligibility

______ Dress Code (for Clinicals)

______Attendance Policy

______Code of Conduct

______General Policies

______Student Grievance Procedure

______Disability Services

Promotional Material/Media Release: (please initial next to either yes or no for each one):

______Yes ______No – I authorize my likeness to be used for any on site promotional materials or displays

(e.g. pictures of graduates on an alumni bulletin board). These would not be

distributed to the general public and would only be visible to individuals who are on

site.

______Yes ______No – I authorize my likeness to be used for any and all promotional or other material

produced by New Beginnings NATP and/or consultants for New Beginnings NATP

(e.g. a picture of a class for a brochure).


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Signature Page (2 of 2)

Acknowledgment of Responsibility:

I acknowledge that it is my responsibility to review all of the information I received in my Student Enrollment Agreement

packet. I agree to abide by all of the policies and procedures listed in the Student Enrollment Agreement Packet, the rules

and guidelines expressed by my instructor(s), as well as the general best practices of New Beginnings NATP. I

acknowledge that failure to follow the aforementioned policies, procedures, rules, guidelines, and practices will result in

disciplinary action up to and including expulsion and without a refund.

If you are unsure about a policy, please feel free to ask a member of the faculty or staff for clarification. In the

absence of faculty or staff, please do your best to utilize sound judgment.

Printed Name:___________________________________________

Signature:___________________________________________ Date:______/______/______

Authorization of Progress Reporting: (for sponsored students only)

I, ___________________________________, hereby authorize New Beginnings Nursing Aide Training Program to

disclose any and all pertinent information regarding my attendance, grades, conduct and overall program status to my

program sponsor(s) and/or sponsoring agency.

Signature:___________________________________________ Date:______/______/______

*ONLY fill in section below if student is a minor (under 18 years old). (Must be completed by student’s

parent/guardian ONLY)*

Parent/Guardian Contact Information:

Name: First Name Middle Initial Last Name

Mailing Address:

Street Address Apt./Ste. City State Zip code

Home Phone: ( ) - Cell Phone: ( ) -

E-mail:

Relationship to Student:

Affirmation of Guardianship/Provision of Consent/Waiver of Liability:

I, ______________________________, hereby affirm that I am the legal guardian of _____________________________

and do hereby provide consent for them to voluntarily participate in the New Beginnings Nurse Aide Training Program. In

consideration of the risk of injury while participating in Nurse Aide Training (henceforth referred to as “the activity"), and

as consideration for the right to participate in the activity, I agree to indemnify and hold harmless New Beginnings NATP

and its partnering Clinical and Non clinical Contract Facilities/Companies against any and all claims, suits, or cause of

actions of any kind whatsoever for liability, damages, compensation, or otherwise brought by me, the student, or anyone

on my or their behalf arising as a result of the student’s participation in the New Beginnings Nurse Aide Training

Program.

Signature:___________________________________________ Date:______/______/______

STUDENT ENROLLMENT AGREEMENT PACKET...2016/05/13 · certificate you receive at the end of the STNA...

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Transcript of STUDENT ENROLLMENT AGREEMENT PACKET...2016/05/13 · certificate you receive at the end of the STNA...