Castor Health Institute, LLC

6 E. 23rd St.

Sterling, IL 61081

815-622-3550

https://www.castorhealthinstitute.com

email: info@castorhealthinstitute.com

THIS IS THE ENROLLMENT FORM FOR THE CERTIFIED NURSING ASSISTANT (CNA) COURSE. IF YOU MEANT TO INSTEAD ENROLL IN THE PHLEBOTOMY COURSE, PLEASE GO BACK AND SELECT THE PHLEBOTOMY ENROLLMENT FORM INSTEAD.

You must be 16 or older to enroll.

We're excited to bring you into our class! Please double-check all fields before clicking "submit" at the end.

To complete this form, you will need a photo or scan of the following documents:

• State ID or Drivers License
• Social Security Card

We will also optionally need a scanned verification of a tuberculosis test. If you have been tested and have the documentation, you will be asked to upload it here. If you don't have it, no worries! We can get that taken care of later on.

No payments will be collected at this time. At the end of this form, you'll be asked to schedule an in-person enrollment appointment. Your initial deposit will be collected at that appointment, and payment plans will be discussed then.

COURSE DESCRIPTION
Nurse Aide Training Program course offers introductory training for the non-licensed individual to provide safe, effective and caring services to patients, residents and clients in a long term care setting. It will provide classroom instruction, practice of clinical skills in the classroom lab setting and in an actual long term care setting. Students will learn about being a contributing member of the health care team, communication and interpersonal skills, infection control techniques, providing personal care, opportunities will be provided within the course schedule at area long term care facilities.
PREREQUISITE: 16 years of age

COURSE OBJECTIVES
The goals and objectives of classroom and clinical settings both the career and technical education and Health Careers curriculum (based on the Illinois Department of Public Health Module Skills Standards). The goals and objectives pertain directly to the following areas:

• Introduction to the Health Care System
• Introduction to the Patient
• Your Working Environment
• Safety
• Cardiopulmonary Resuscitation
• Lifting, Moving, and Transporting Patients
• The Patients's Unit
• Basic Anatomy
• Personal Care of the Patient
• Nutrition
• Fluid Balance
• Observation and Recording Vital Signs
• Supportive Care
• Fundamentals of rehabilitation
• Patient Care Planning
• The Patient in Isolation
• Care of the terminally ill patient
• Alzheimer's Disease and Related Dementia

CLINICAL SESSIONS will involve demonstrations, skills practice, observation, hands on client care experiences, working with facility staff and clinical instructors.

CLINICAL OBJECTIVES
Upon completion of the clinical sessions, the student will be able to:

• Work cooperatively with other nursing and health care professionals
• Follow facility procedures related to student/nurse aide scope of practice
• Convey respect for staff, patients, fellow students and instructors
• Preserve and protect client's autonomy, dignity, and rights
• Take the initiative to seek out learning experiences
• be self directed in utilizing time and setting priorities
• Proficiently perform nursing care or tasks

All classes offered at Castor Health Institute will provide the 120 minimum clock hours required per IDPH guidelines to meet all lecture and clinical hours required for Illinois Nurse Aide Certification.

All classes offered at Castor Health Institute will be offered over no more than a 4 month period to meet all lecture and clinical hours required for Illinois Nurse Aide Certification.

ITEMIZATION & TOTAL TUITION FEES

TUITION FEE: $1,400

NON-REFUNDABLE REGISTRATION FEE: $150 (includes textbook, supplies, and admin fees)

CONSUMER INFORMATION

• 40 Students were admitted in the program as of 7/1/2023-6/30/2024 reporting period.
• 39 new starts to the Training CNA Program during the 12-month reporting period of 2023.
• 39 students enrolled in the program during the 12-month reporting period and 32 students completed CNA Program.
• 39 students enrolled in the Lifetime of Caring Training CNA Program were placed in their field of study
• 39 students enrolled in Lifetime of Caring Training CNA Program took a state licensing exam and 32 passed the state exam during the 12-month reporting period of 2018.
• 32 of the graduates obtained employment in the field.
• The average salary for all school graduates is $15.00/hr.

REPORTING STUDENT COMPLAINTS
ILLINOIS BOARD OF HIGHER EDUCATION
1 N. OLD STATE CAPITAL PLAZA, SUITE 333
SPRINGFIELD, IL. 62701
217-782-2551
www.complaint.ibhe.org

DEPARTMENT OF PUBLIC HEALTH
Randy Carey-Walden RN, MSN, PSA
525 WEST JEFFERSON ST. 4TH FLOOR
SPRINGFIELD, IL. 62761
217-785-5569
www.dph.illinois.gov

STUDENT RIGHT TO CANCEL
The student has the right to cancel the initial enrollment agreement before the first day of class. 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 full refund on all monies paid to day within 7 days of cancellation. Cancellation should be submitted to the authorized official of the school in writing.

TUITION REFUND/CANCELLATION POLICY
Refund calculations are based on the date of withdrawal/termination from the program. If a student wishes to withdraw prior to the first day of class, refunds will be made after all non-refundable expenses listed have been deducted. No refund of any kind will be issued if cancellation or withdrawal happens on or after the first day of class.

If the institution terminates the student’s enrollment for failure to maintain satisfactory progress; failure to abide by the rules and regulations of the institution; absences in excess of the maximum set forth by the institution; and/or failure to meet financial obligations to the school, NO REFUND will be issued.

In cases of prolonged illness, accident, or death in the family, or other unavoidable circumstances that make it impractical to complete the program, the institution will make a settlement that is reasonable and fair to both parties.

NOTICE TO STUDENT

• Do not sign this agreement before you have read it or if contains any blank spaces
• This agreement is a legally binding instrument and is only binding when the agreement is accepted, signed, dated by all authorized officials of the school or the admissions officer at the school’s principal place of business. Read all pages of this contract before signing.
• You are entitled to a copy of the agreement and any disclosure pages you sign.
• This agreement and the school catalog constitute the entire agreement between the student and the school.
• 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.
• 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.

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, Castor Health Institute 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, 1N. Old State Capitol Plaza Suite 333 Springfield, IL 62701 or at www.ibhe.org.

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.

Illinois Department of Public Health

Health Care Worker Background Check Authorization and Disclosure for Criminal History Records Information (CHRI) Check

I hereby authorize the Illinois Department of Public Health (the Department), the Department's designee, educational entities that train and/or test health care workers, staffing agencies, my current or potential employer, or a health care facility where I want to volunteer to initiate/request a CHRI check on me. I further authorize the Illinois State Police (ISP) and/or the Federal Bureau of Investigation (FBI) to release information and photographs relative to the existence or nonexistence of any criminal record, which it might have concerning me, to any initiator/requestor solely to determine my suitability for training or testing in a health care training program, employment, continued employment, or to work as a volunteer. I further authorize any entity that maintains criminal records and photographs relating to me, including but not limited to a local unit of government in any State, to release those records and photographs to the ISP, FBI, or the Department. I authorize the Department to provide any health care facility, training program or staffing agency, to which have provided this authorization and disclosure form, a copy of my ISP CHRI and a determination of eligibility of the ICHRI. I certify that the ISP, FBI, any entity that maintains criminal records and photographs, the Department, and any of their employees or officers who furnish this information shall be held harmless from all liability, which may be incurred as a result of releasing such information. I further acknowledge that a educational entity or a health care employer shall not be liable for the failure to hire or retain me as an applicant, student, employee, or volunteer ifI have been convicted of committing or attempting to commit one or more of the offenses stated in the Health Care Worker Background Check Act (225 ILCS 46/25

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I understand that any false statements or deliberate omissions on this document may be grounds for disqualification from employment, training, or volunteering, if discovered after employment, training, or volunteering begins, and can result in discipline up to and including my termination of employment, being a volunteer, or a student.

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I understand that the information requested below regarding gender, race, height, eye color, hair color, weight, place of birth and date of birth is for the sole purpose of identification and the accurate gathering of the criminal history record information, and that it will not be used to discriminate against me in violation of the law. I understand that the provision of my Social Security number is required by law. A facsimile or photographic copy of this authorization will be as valid as the original.

A - Chinese, Japanese, Filipino, Korean, Polynesian, Indian, Indonesian, Asian Indian, Samoan, or any other Pacific Islander.

B - Black or African American (Not Hispanic or Latino)

H - Hispanic or Latino (Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin), American Indian, Eskimo, or Alaskan native, or a person having origins in any of the 48 contiguous states of the United States or Alaska who maintains cultural identification through tribal affiliation or community recognition.

U - Of undeterminable race. Of Untold mixture.

W - Caucasian (not Hispanic or Latino)

I certify that all information I have provided above is true and correct.

Take a photo or make a scan of the following documents and upload them here. Make sure they are clearly visible and readable.

READ CAREFULLY:

To finalize your enrollment, you will need to come in-person to our Sterling office for a short appointment. During the appointment, our program manager Abigayle Miller (Abby) will get to know you, verify your identity, address any questions you may have, and discuss payment and payment plans.

The best option is to come in during one of our ENROLLMENT DAYS.

If you cannot make any of the enrollment days, then we will reach out to you to schedule your enrollment appointment.

For your appointment, you will need to bring:

• Your State ID or Drivers License
• Your Social Security card
• [Optionally] Your tuberculosis test
• Your nonrefundable deposit of $150

All appointments are at :

417 E. 3rd St. Suite B

Sterling, IL 61081

Soon after submitting this form, you will receive an email with the above information concerning your enrollment appointment.