Vital Academy Admissions Form

Enroll for Vital Academy

Compassion in Practice, Excellence in Care
STUDENT INFORMATION
Student Name*

First NameMiddle InitialLast Name
Birth Date*

MonthDayYear
Gender*

MaleFemale
Race*
Phone*
Ethnicity*
E-mail Address*
example@example.com
Social Security*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Do you speak any languages other than English?

YesNo
Please list them
Education
High School or Equivalent Name
Graduation Date

MonthDayYear
Date
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Program Information

Program: CNA Certification
Please select a program and class dates:
6-Week Evening Program*
6-Week Day Program*
Cancellation and Refund Policy
Students must give written notice of cancellation including name, date and reason for cancellation to: Program Director, Vital Academy LLC, 853 Washington Blvd 66101. When notice of cancellation is given within 3 days after the date the enrollment agreement is signed (not including Saturdays, Sundays or holidays) students shall receive a refund of all monies paid. When notice is given after the cancellation period but prior to the close of business on the student’s first day of class attendance, the school may retain the application fee and the cost of uniforms. When notice of cancellation is given after the student’s completion of the first day of class attendance, the school may retain the application fee, the cost of uniforms, and a percentage of the tuition.

10% complete---90% refund
20% complete—80% refund
30% complete—70% refund
40% complete—50% refund
50% complete—40% refund
60% or more complete—no refund is given

Agreements
NOTICE TO BUYER
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. The contract is binding only when the agreement is accepted, signed, and dated by the student and the authorized official of the school or the admissions officer at the school’s principal place of business. Read the entire contract before signing.
3. You are entitled to an exact copy of this agreement and any disclosure pages you sign.
4. This agreement and the school handbook constitute the entire agreement between the student and the school.
5. The school does not guarantee job placement to graduates upon program completion.
6. The school reserves the right to reschedule the program start date when the number of students scheduled is too small to have an actual class.
7. The school reserves the right to terminate a student’s training for unsatisfactory progress, nonpayment of tuition, or failure to abide by established standards of conduct as outlined in the student handbook.
8. The school does not guarantee the transferability of credits to a college, university, or institution. Any decision on the comparability, appropriateness, and applicability of credit and whether they should be accepted is the decision of the receiving institution.
STUDENT ACKNOWLEDGMENTS
1.I hereby acknowledge receipt of the school’s student handbook, which contains information describing the program offered.
Student initials:Initial Here*
2.I have carefully read and received an exact copy of this enrollment agreement.
Student initials:Initial Here*
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 and satisfactory academic progress as described in the student handbook and that my financial obligation to the school must be paid in full before a certificate may be awarded.
Student initials:Initial Here*
4.I understand that the school does not guarantee job placement to graduates upon program completion.
Student initials:Initial Here*
5.I understand that complaints that cannot be resolved by direct negotiation with the school in accordance with its written grievance policy may be filed with the Kansas Board of Regents: Kansas Board of Regents Complaint Process
Student initials:Initial Here*
Acceptance
I, the undersigned, have read and understand this agreement and acknowledge receipt of a copy. It is further understood and agreed 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. I also understand that if I default upon this agreement, I will be responsible for the payment of any collection fees or attorney fees incurred by the school.

My signature below signifies that I have read and understand all aspects of this agreement and do recognize my legal responsibilities regarding this contract.
Signed this DateDate* .
Signature of Student: Signature*

Signature of Director _______________________________ Date _______________________*
*Signed by Director after Acceptance
Representative's Certification

This portion is signed by Director after Acceptance
I hereby certify that __________________________________________________ has been interviewed by me and in my judgment meets all requirements for acceptance as a student in the __________________________________ program as described in the student handbook. I further certify that there have been no verbal or written agreements or promises other than those appearing on this agreement.

Application Fee

Students must pay all tuition and fees before the end of the first week of the program.
$20.00 Application Fee

$820.00 Tuition

$40.00 Uniform

$20.00 Test Registration Fee

$40.00 Testing Fee (State Exam)

$10.00. Background Check

$35.00 TB Skin Test

___________________________
$985.00 Total Cost of Program

Students must pay all tuition and fees before the last week of the program.
Due Today*

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USDApplication Fee

Payment Methods

Debit or Credit Card

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Enroll for Vital Academy

STUDENT INFORMATION

Education

Program Information

Cancellation and Refund Policy

Agreements

NOTICE TO BUYER

STUDENT ACKNOWLEDGMENTS

Acceptance

Representative's Certification

Application Fee