Emerald Valley Institute Application For Enrollment & Enrollment Agreement  Logo
  • Application For Admission - No Fee

    A Emerald Valley Institute | 40 E. Broadway, Suite 213; Eugene, OR 97401 | info@emeraldvalleyinstitute.com | www.emeraldvalleyinstitute.com |(541) 525-3524. A Emerald Valley Institute prohibits discrimination against its customers, employees, and applicants for employment and student applicants on the bases of race, color, national origin, age, disability, sex, gender identity, religion, reprisal, and where applicable, political beliefs, marital status, from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by A Emerald Valley Institute
  • Start Your Journey — Estimated Completion Time: 15 Minutes

    You’ll see some information repeated in different sections. We know it’s a bit redundant, but it ensures every part of your application meets program and licensing requirements.
  • Affordability & Tuition Accessibility


    One of Emerald Valley Institute’s core missions is to eliminate economic barriers to education and training. We are committed to offering tuition at accessible rates so that every student who is granted admission can afford to complete the program. To support this mission, we provide tuition reductions and flexible payment plans on a case-by-case basis.

    In addition, Emerald Valley Institute will match any tuition offer, scholarship, or reduction a student has received from another licensed psilocybin facilitator training program where they have been accepted. This means that if another licensed program has offered you a lower tuition rate or scholarship, we will match that final tuition amount to ensure cost is never a barrier to your participation.

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  • đź’š Tuition & Accessibility

  • Note to applicants:
    Emerald Valley Institute offers tuition reductions, flexible payment plans, and a limited number of “Pay-What-You-Can” seats each session as part of our commitment to accessibility and equity. Every student who needs assistance is offered support — no strings attached.

  • Admissions Interview Questions

    Please write a short response to the following questions:
  • Military and Veteran Information

  • Disability Status

  • Demographic Information

    To comply with federal statistical reporting requirements, A Emerald Valley Institute must ask the following demographic questions. We encourage you to provide this information, but doing so is entirely voluntary, and your application will receive the same consideration whether or not you do.
  • Contact In case of Emergency

  • By Signing this application, I certify that the information I have provided above are true to the best of my knowledge without any malice or any intention to commit acts of misrepresentation.

    I am aware that any false, misleading, or deceptive information provided may lead to withdrawal, expulsion, or any disciplinary action which may be dealt with by the school's authorities.

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  • 🌿Congratulations You have Finshed Your Application Process- Please click NEXT until you reach the Submit button

    You can choose to fill out the rest of the optional sections or you can opt to scroll and or click through the next pages and click "SUBMIT" to finish your application

     

    What Happens Next
    Once you submit your admissions application, our team will review it and send you an admissions decision within 24–48 hours via email.
    If you don’t see your message within that time, please check your spam, junk, or promotions folders, as it may land there if we’re not yet in your contact list.

    If you’re offered admission, you’ll receive a follow-up email from our Admissions Department inviting you to set up your student portal, which gives you early access to your online classroom. That email will also include your course schedule, a program overview, and tuition information to help you prepare for the start of your training.

    If you’d like to connect before or after your decision, you’re welcome to schedule a call through our Calendly link, or you can call, text, or email us any time:
    📞 541-525-3524 — please leave your name and chosen start date if texting or leaving a voicemail
    ✉️ admissions@emeraldvalleyinstitute.com

    We’re happy to help with any questions as you prepare for your journey at Emerald Valley Institute.

  • Optional Section: Getting the Paperwork Out of the Way if you do not wish to complete this section- leave the following sections blank, scroll to the bottom and click the submit button to complete your application

    This section is completely optional and is included here only to make things easier for you later. Filling it out now helps us get required paperwork out of the way so your enrollment process is smoother if you’re accepted — but it’s not required to apply to the program
  • 🌿 Terms & Conditions — The Following Sections Only Apply After You Accept Admittance and is Not Binding Until You Agree to Enrollment and Attend Your First Day of Class:

  • 🌿Student Enrollment Agreement Overview

    40 E Broadway St. Suite 213 Eugene OR 97401 541-525-3524 admissions@emeraldvalleyinstitute.com
  • This section explains the terms you’ll agree to:

    If you are accepted into the program, enroll in the program and after you attend your  first day of class or begin your self-directed coursework.

    Completing this form allows Emerald Valley Institute to process your application and prepare your student portal so that, once accepted, you can be seamlessly enrolled without requiring you to spend time doing additional paperwork.

    Submitting your application does not make this agreement active and does not legally bind you at this stage.

    Your agreement with Emerald Valley Institute only becomes valid once you’ve been accepted, enroll in the program, your student portal has been created, and you begin your program—either by attending your first class or starting your self-directed coursework in the classroom.

    We include this now to make the process smooth and transparent, so you fully understand your tuition, cohort placement, and next steps once you’re ready to begin.

    By completing this application, you acknowledge that you’ve reviewed and understand the following terms, which will take effect upon your official start date.

  • The Official Stuff (Made Simple)

  • 1. Emerald Valley has the ability to offer tuition reductions for qualifying students, if you are chosen for a tuition reduction the cost of tuition will be the cost of the agreed upon tuition reduction. 

    2. You are entitled to an exact copy of this agreement and any disclosure pages you sign. This agreement and the school catalog constitute the entire agreement between the student and the school. 

    5. Although the school may provide placement assistance, the school does not guarantee job placement to graduates upon program completion or upon graduation. 

    6. While the school will make all reasonable efforts to prepare students for their OHA facilitator exam,the school does not guarantee students will pass the exam upon program completion.

    7. The school reserves the right to reschedule the program start date when the number of students scheduled is too small, or for unforeseen regulatory complications and other events of “force majeure” (as defined below in Section 8) resulting in program delay

    8. The school reserves the right to terminate a students’ training for unsatisfactory progress, nonpayment of tuition or failure to abide established standards of conduct.

    9. 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.

    10. The school (may/will) perform a background check for purposes of verifying that students will not be barred by OHA from receiving a facilitator license. OHA will perform background check to determine fitness for certification as a facilitator. 

    11. Completion of the training program does not provide certification to practice medicine, psychotherapy, or like professions requiring board certification. The training program is specially tailored for students to receive an OHA facilitator license. 

    12. If accepted for admissions you will be enrolled in the training program for the date selected on the application. 

    13. The Enrollment Agreement (“Agreement”) is between A Emerald Valley Institute LLC, an Oregon limited liability company (“TrainingProvider”), and the individual specified on the signature page of this Agreement (“Applicant”).

  • EVI Student ENROLLMENT AGREEMENT (Optional)

    Please Note: This is Only Binding if student accepts enrollment and begins their self directed learning or attends live lecture
  • *Please note that providing your social security number is optional and will be used to verify identity and for background checking purposes. Please see our JotForm security protocol below for protecting sensitive information: 

    A Emerald Valley Institute utilizes JotForm for online application and enrollment processes. All forms are served across a protected 256 bit SSL (Secure Socket Layer) connection that uses a SHA256 Certificate. It is the industry standard protection. Submissions are encrypted with high-grade RSA 2048 at the user's computer, then transferred and stored securely on JotForm servers. JotForm is committed to upholding the five SOC 2 Trust Service Principles and received an audit report on SOC 2 compliance from an independent auditor, ensuring that they meet the latest security standards.

  • Program Overview and Program Description: 


    This program covers an OHA and HECC approved curriculum and offers a certificate of completion upon successful completion of the program. This type of certification from a certified training program is necessary to receive a Psilocybin Facilitator license from OHA.


    Program Length in Weeks: 10 weeks - 12 months

    11 Weeks of Live Lectures, students have up to 12 months to complete their program requirements


    Days of Live Lectures: 

    Monday, Wednesday, Friday

    6p - 8p (pst) *classes may go later as needed


    Enrollment Date Distance Learning: The start date of your self directed coursework

    Enrollment Date Standard, Accelerated: The start date of your accepted enrollment and or your first live lecture


    Start Date Distance Learning: The start date of your self directed coursework

    Start Date Standard and Accelerated program: The start date of your first live lecture

    Total Credit/Clock Hours: 160 Hours 

    Practicum In Person Hours: 40 Hours (included in the 160 clock hours) 

     

    TUITION:

    If needing a tuition reduction or a payment plan the tuition amount below will be modified to reflect these changes from our regular tuition rates.

    Application Fee: $0


    Enrollment Down Payment:

    We have multiple options available, the student can choose to pay for their program in full, or split the tuition payment into 3 equal payments upon enrollment in their program. Students who need it can also elect to not have a downpayment for their tuition if it creates an economic barrier to them.

    If a student submits a downpayment the downpayment will be the first payment and applied to their total cost of tuition. .

     

    Standard Program:

    Tuition Cost: $3995
    Books & Other: $0
    Other: Students traveling for in person practicum will need to cover any food, travel or lodging costs as their own expense
    Total Program Cost: $3995

    Accelerated Program:

    Tuition Cost: $4500
    Books & Other: $0
    Other: Students traveling for in person practicum will need to cover any food, travel or lodging costs as their own expense
    Total Program Cost: $3995

    Distance Education Certificate:

    Tuition Cost: $2,995
    Books & Other: $0
    Other: Students will need to add their in person practicum 40 hour training to this course to be able to sit for state licensure
    Total Program Cost: $2,995

     

    Program Terms, Policies & Student Rights

    A. Training Provider is in the business of: (i) providing an Oregon - based digital training for psilocybin service facilitators (ii) administering an Oregon -based digital education program for psilocybin service facilitators titled Psilocybin Facilitator Training Program (the “ Program”); and (iii) providing in-person practicum facilitator training per (OAR 333-333-3070). 

    SECTION 1 TRAINING SERVICES 

    1.1 Training Services. Subject to the terms and conditions of this Agreement, Training Provider will provide to the Applicant the training services set forth on this agreement. 

    1.2 Program Dates. The Program will commence on the student enrolled “Start Date” and end 12 months following the Start Date (the “Term”). 

    1.3 Program Materials. Training Provider will provide access to all program materials via online student classroom, live lectures, in person training, video library, synchronous online learning, and email. 

    1.4 Completion Certificate. Upon Applicant’s successful completion of the Program and compliance with the rules and requirements set forth on the attached Exhibit B (the “Rules and Requirements”), Applicant will receive a certificate of completion (“Completion Certificate”); provided, however, that Training Provider may deny the issuance of a Completion Certificate if, in the Training Provider’s sole discretion: (a) Applicant did not fully comply with the Rules and Requirements, or (b) Training Provider believes Applicant cannot meet certain ethical and professional standards of conduct that renders the Training Provider unable to endorse the student as qualified to provide psilocybin services (even if Applicant fully complied with the Rules and Requirements) A lead educator or program director must endorse each student as qualified to provide psilocybin services as a condition of completing the training program per OAR 333-333-3090(4). 

    1.5 Training Provider may make reasonable modifications to the Rules and Requirements at any time, in its sole discretion, however if any revisions are made that impact the student’s enrollment agreement, pertaining to their tuition payment(s) for example,

    Tuition Refunds:

    If cancellation occurs within five business days of the date of enrollment, and before the commencement of classes, all monies specific to the enrollment agreement shall be refunded. *Entire amount applicant has paid will be refunded. If cancellation occurs after five business days of the date of enrollment, and before the commencement of classes *Entire amount applicant has paid will be refunded. Withdrawals that occur after commencement: Applicants will be entitled to a pro-rata refund of training program and prior to 50% on any monies collected by the training completion of the training program.Provider withdrawals that occur after commencement: No refunds provided of training program and after 50% completion of the training program

     

  • SECTION 2 — REPRESENTATIONS AND WARRANTIES OF APPLICANT
    Applicant represents and warrants to Training Provider as follows:

    Age and Capacity. Applicant is an individual at least 21 years of age and has the capacity, power, and authority to sign and deliver this Agreement and to perform all obligations hereunder. This Agreement constitutes a legal, valid, and binding obligation of Applicant, enforceable in accordance with its terms, except as enforceability may be limited by bankruptcy, insolvency, or similar laws or general principles of equity.

    Accuracy of Applicant Information. All information provided to Training Provider prior to signing this Agreement, including but not limited to the Program Application or Criminal Background Check Release (collectively, “Original Applicant Information”), is accurate in all respects, subject only to any corrections or updates provided prior to signing.

    Acknowledgments. Applicant understands, acknowledges, and agrees that:
    (a) Producing, manufacturing, processing, possessing, distributing, selling, or using psilocybin is a crime under the Federal Controlled Substances Act of 1970 (“Federal CSA”);
    (b) Providing facilitation or other services to an individual who buys, possesses, or uses psilocybin may itself be a crime under the Federal CSA, regardless of when the services are provided;
    (c) Training Provider is not requiring or encouraging Applicant to violate the Federal CSA or any other applicable law;
    (d) Although some of Training Provider’s agents or representatives may be licensed mental health professionals, none are acting in that capacity in connection with the Services and will not be liable to Applicant as such; and
    (e) Training Provider does not provide insurance for Applicant and Applicant is solely responsible for obtaining personal or professional insurance coverage as desired.


    SECTION 3 — OBLIGATIONS OF APPLICANT
    Rules and Regulations. Applicant agrees to comply with all applicable school Rules and Regulations.

    Applicant Information. Applicant will promptly provide accurate responses to any request from Training Provider to verify or update Original Applicant Information, or to supply additional information (“New Applicant Information”). If any information becomes inaccurate, Applicant must notify Training Provider within one (1) business day of the change.

    Computer Equipment and Software. Applicant must have a working computer and stable internet connection sufficient to access the portals and software platforms required for participation, including Zoom.

    Indemnification. Applicant agrees to defend, indemnify, and hold harmless Training Provider from and against any and all claims, actions, damages, liabilities, or expenses (including reasonable attorney’s fees) resulting from or arising out of any breach of this Agreement by Applicant.


    SECTION 4 — PRIVACY POLICY
    All Original Applicant Information and any New Applicant Information provided by Applicant will be subject to Training Provider’s Privacy Policy, attached as Exhibit C.


    SECTION 5 — INTELLECTUAL PROPERTY
    5.1 Ownership of Intellectual Property. Applicant acknowledges that all materials and information provided by Training Provider in connection with the Emerald Valley Institute Facilitator Training Program (“Emerald Valley Institute Materials”) are the exclusive property of Training Provider. This includes all copyrights, trademarks, and other intellectual property and proprietary rights (“Training Provider’s Intellectual Property Rights”). Applicant will not acquire any ownership interest in such materials and may not reproduce, distribute, or publish any part of the Emerald Valley Institute Materials without prior written consent.

    5.2 License Grant. Subject to this Agreement, Training Provider grants Applicant a limited, non-exclusive, non-transferable, non-sublicensable license to use the Emerald Valley Institute Materials during participation in the program and for no other purpose. After completion, Applicant may retain copies solely for personal reference, but may not display, publish, or distribute any materials publicly or to third parties.

    5.3 Termination of License. Upon termination of this Agreement, Applicant must immediately cease all use of Training Provider’s portals and materials unless expressly permitted under Section 5.2.


    SECTION 6 — LIMITED WARRANTY, DISCLAIMERS, LIMITATION OF LIABILITY, AND ASSUMPTION OF RISK
    6.1 Limited Warranty. Training Provider warrants that the Services will be performed by qualified personnel in a professional manner.

    6.2 General Disclaimer of Warranties. Except for the limited warranty above, Training Provider expressly disclaims all other warranties, express or implied, including but not limited to any arising from course of performance, dealing, or trade usage.

    6.3 Specific Exclusions. Training Provider makes no warranty that:
    (a) Applicant will successfully complete the program;
    (b) Completion will result in skills that may lawfully be used;
    (c) Completion will guarantee qualification for a psilocybin facilitator license under Oregon law or passage of the OHA exam; or
    (d) The program materials are entirely accurate or complete.

    6.4 Limitation of Liability. The Training Provider’s total liability to Applicant under this Agreement, for any cause of action, will not exceed the amount Applicant has actually paid under this Agreement. Training Provider will not be liable for any indirect, special, incidental, consequential, or punitive damages, even if advised of their possibility. The price charged reflects this limitation of liability.

    6.5 Assumption of Risk. Applicant acknowledges that participation involves inherent risks, including illness, personal or psychological injury, pain, suffering, disability, or death. While Training Provider takes measures to reduce risk, no guarantee of safety can be made. Applicant voluntarily assumes all risks, whether caused by ordinary or gross negligence of Training Provider or otherwise.


    SECTION 7 — FORCE MAJEURE
    Neither party will be liable for failure to perform obligations under this Agreement due to events beyond reasonable control (“Force Majeure Events”), including but not limited to pandemics, natural disasters, war, civil unrest, terrorism, or government actions. If performance is delayed, the affected party must notify the other promptly.


    SECTION 8 — TERMINATION
    8.1 Termination by Training Provider. Training Provider may terminate this Agreement upon written notice if Applicant:
    (a) Fails to make payment when due and does not cure within 15 days;
    (b) Breaches this Agreement and fails to cure within 10 days after notice;
    (c) Commits repeated material breaches;
    (d) Engages in dishonest, illegal, or discriminatory conduct in connection with the program;
    (e) Provides false or misleading information;
    (f) Is affected by a Force Majeure Event delaying obligations beyond 30 days; or
    (g) Violates the school’s student conduct policy.

    8.2 Termination or Withdrawal by Applicant. Applicant may terminate this Agreement upon written notice if:
    (a) Training Provider materially breaches and fails to cure within 30 days;
    (b) A Force Majeure Event delays obligations beyond 30 days; or
    (c) Applicant qualifies for termination under OAR 715-045-0036 through 715-045-0038.
    If terminated for qualifying reasons, Training Provider will refund amounts paid in accordance with its refund policy.

    8.3 Revocation of Participation and Access. Upon termination, Applicant will lose access to all program portals, materials, and group communications and may not participate further in the program.

    8.4 Effect of Termination. Termination does not relieve either party of obligations accrued prior to termination. Provisions reasonably expected to survive termination will remain in effect.


    SECTION 9 — GENERAL PROVISIONS
    9.1 Assignment. Applicant may not assign or delegate any rights or obligations without prior written consent. This Agreement binds and benefits the parties and their permitted successors and assigns.

    9.2 Governing Law. This Agreement is governed by the laws of the State of Oregon, without regard to conflict-of-law principles.

    9.3 Arbitration. Applicant must first exhaust the school’s internal grievance process. Thereafter, any dispute will be resolved by binding arbitration before a single arbitrator in Portland, Oregon, pursuant to ORS 36.600–36.740. The arbitrator’s decision is final and may be entered as judgment in a court of competent jurisdiction.

    9.4 Attorney’s Fees. The prevailing party in any arbitration or action arising from this Agreement is entitled to recover reasonable attorney’s fees, costs, and expenses, as determined by the arbitrator or court.

    9.5 Entire Agreement. This document constitutes the entire understanding between the parties and supersedes all prior agreements or representations. Amendments must be in writing and signed by both parties. If any provision is found unenforceable, the remaining provisions will remain in full force and effect.

  • Section 10 Non-Discrimination Policy

    10.6 Non-discrimination Policy. Training Provider recognizes the contribution of Indigenous communities,BIPOC, Women, and people from the LGBTQIA+ communities in carrying plant medicine and forwarding psychedelic healing modalities. We seek to honor all those who have carried these medicines for eons despite facing persecution, cultural appropriation, extractive colonialism, and historical erasure. Wewelcome individuals from these communities and are constantly seeking ways to include these voices.We use our unearned privileges to collaborate with and support others in and from historically marginalized and oppressed communities so that they, too, may benefit from equitable access to these traditional, healing medicines and practices in a safe and welcoming space. We develop honest relationships and opportunities with diverse partners and colleagues, supporting historically marginalized communities to ensure equitable access to new modalities of treatment. With this work,we are in constant growth and reflection of our personal and collective journeys and understanding of power privilege. We observe our steps forward, walking with respect and humility, listening more than we speak, building community and reciprocity. As such, we do not discriminate for admission on the basis of sex, age, race, color, religion, ethnic origin, or sexual orientation. We aspire to hire for adiverse psychedelic future. People from varied cultural backgrounds, beliefs, walks of life, ethnicities,races, nationalities, genders, ages, sexual orientations, abilities, and educational and professional backgrounds will together be better able to understand the complexity and nuance of the work at hand,by contributing views and practices that are often embedded in lived experiences and particular perspectives. A Emerald Valley Institute prohibits discrimination against its customers, employees, applicants and students on the basis of race, color, national origin, age, disability, sex, gender identity, religion, reprisal and where applicable political origin, beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual’s income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted with or funded by A Emerald Valley Institute. 

  • Student Cancellation Rights:

    APPLICANT IS ALLOWED TO CANCEL THEIR APPLICATION AND ENROLLMENT IN THE PROGRAM AT ANY TIME. APPLICANT IS ENTITLED TO A REFUND AS DESCRIBED IN OAR 715-045-0036 through 715-045-0038. 

    CANCELLATION AND REFUND POLICIES FOR RESIDENT EDUCATION

    Cancellation and Refund Policy: Resident Instruction (OAR 715-045-0036)(1) A student may cancel enrollment by giving written notice to the school. Unless the school has discontinued the program of instruction, the student is financially obligated to the school according to the following:(a) If cancellation occurs within five business days of the date of enrollment, and before the commencement of classes, all monies specific to the enrollment agreement shall be refunded;(b) If cancellation occurs after five business days of the date of enrollment, and before the commencement of classes, the school may retain only the published registration fee. Such fee shall not exceed 15 percent of the tuition cost, or $150, whichever is less;(c) If withdrawal or termination occurs after the commencement of classes and before completion of 50 percent of the contracted instruction program, the student shall be charged according to the published class schedule. The student shall be entitled to a pro rata refund of the tuition when the amount paid exceeds the charges owed to the school. In addition to the prorated tuition, the school may retain the registration fee, book and supply fees, and other legitimate charges owed by the student;(d) If withdrawal or termination occurs after completion of 50 percent or more of the program, the student shall be obligated for the tuition charged for the entire program and shall not be entitled to any refund;(e) The enrollment agreement shall be signed and dated by both the student and the authorized school official. For cancellation of the enrollment agreement referenced in Subsections (1)(a) and (b), the"date of enrollment" will be the date that the enrollment agreement is signed by both the student and the school official, whichever is later.(2) Published Class Schedule (for the purpose of calculating tuition charges) means the period of time between the commencement of classes and the student's last date of attendance as offered by the school and scheduled by the student.(3) The term "Pro rata Refund" means a refund of tuition that has been paid for a portion of the program beyond the last recorded date of attendance.(4) When a program is measured in clock hours, the portion of the program for which the student will be charged is determined by dividing the total clock hours into the number of clock hours accrued according to the published class schedule as of the last date of attendance.(5) When a program is measured in credit hours, the portion of the program for which the student will be charged is determined by dividing the total number of weeks into the number of weeks accrued according to the published class schedule as of the last date of attendance.(6) For other measurements of time such as days or weeks, the portion of the enrollment period for which the student will be charged is determined by dividing the total number of days or weeks into the number of days or weeks, accrued according to the published class schedule as of the last date of attendance.(7) The term "tuition cost" means the charges for instruction including any lab fees. "Tuition cost" does not include application fees, registration fees, or other identified program fees and costs. The school shall adopt and publish policies regarding the return of resalable books and supplies and/or the prorating of user fees, other than lab fees.(8) The school shall not charge a withdrawal fee of more that $25.(9) The school may adopt and apply refund calculations more favorable to the student than those described under this policy.(10) When a cancellation, withdrawal, termination, or completion occurs, a calculation of all allowable charges under this rule shall be made. If such calculations evidence that the school received total payments greater than its allowable charges (a) Within 40 days after notification of such cancellation, withdrawal, termination, or completion, a written statement showing allowable charges and total payments received shall be delivered to the student by the school, together with a refund equal in amount to monies paid to the school in excess of those allowable charges;(b) In the event payments to a student account are derived from federal and/or state tuition assistance program(s), including student loan programs, regulations governing refund notification and awarding within respective program(s) shall prevail in lieu of Section (10)(a) of this rule, but only with respect to the covered portions thereof; and(c) In the event payments to a student account are derived from a sponsoring public agency, private agency, or any source other than the student, the statement of charges and payments received together with an appropriate refund described under section (10)(a) of this rule may be delivered instead to such party(ies) in interest, but only with respect to the covered portions thereof.(11) In case of disabling illness or accident, death in the immediate family, or other circumstances beyond the control of the student that causes the student to leave school, the school shall arrange a prorated tuition settlement that is reasonable and fair to both parties.(12) A school shall be considered in default of the enrollment agreement when a course or program is discontinued or canceled or the school closes prior to completion of contracted services. When a school is in default, student tuition may be refunded by the school on a pro rata basis. The pro rata refund shall be allowed only if the Commission determines that the school has made provision for students enrolled at the time of default to complete a comparable program at another institution. The provision for program completion shall be at no additional cost to the student in excess of the original contract with the defaulting school. If the school does not make such provision, a refund of all tuition and fees shall be made by the school to the students.

  • SECTION 12 Student Acknowledgements.

    I hereby acknowledge receipt of the Training Provider’s program offering. The Training Provider’s course catalog is included as part of this Enrollment Agreement and I acknowledge that I have received a copy of such catalog. I have carefully read and received an exact copy of this Enrollment Agreement.

    I have carefully read and received an exact copy of this Enrollment Agreement. I understand that the Training Provider 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 this agreement. While enrolled in the training, I understand that I must maintain satisfactory academic progress as described in the training catalog and that my financial obligation to the. Training Provider must be paid in full before a certificate may be awarded

    I understand that the Training Provider does not guarantee job placement to graduates upon training completion or upon graduation

     

    I understand that complaints, that cannot be resolved by direct negotiation with the Training Provider in accordance to its written grievance policy, and are in direct violation of an Oregon Revised Statute (ORS)or an Oregon Administrative Rule (OAR) may be filed with the Higher Education Coordinating Commission, Private Career Schools Unit, 3225 25th Street SE Salem, Oregon 97302.All student complaints must be submitted in writing. Any inquiry a student may have regarding this contract may be made in writing to (A Emerald Valley Institute 40 E Broadway St suite 213 Eugene OR 97401) or to the Higher Education Coordinating Commission, Private Career Schools Unit, 3225 25th Street SE Salem, Oregon 97302 or by calling 503-947-5716

    I understand and have read the tuition refund policy

    I undertstand and have read the non-discrimination policy

    A Emerald Valley Institute LLC prohibits discrimination against its customers, employees, and applicants for employment on the bases of race, color, national origin, age, disability, sex, gender identity,religion, reprisal, and where applicable, political beliefs, marital status, familial or parental status, sexual orientation, or all or part of an individual's income is derived from any public assistance program, or protected genetic information in employment or in any program or activity conducted or funded by A Emerald Valley Institute LLC 

    Section 13 Enrollment Agreement Additional lnformation: 

    EXHIBIT A 

    Services 

    The Services include the following: 

    10 weeks of coursework and modules, including: 

    Weekly 3 evening 160-minute synchronous teaching sessions; 

    40 hour in person practicum training classes over the course of the training program;▪ Weekly and monthly asynchronous assignments, assessments, and online small group meetings as required. 

    Final assessment & completion including: 

    Final assessment in written and role play formats▪ Certificate of Completion▪ Completion ceremony 

    Forty (40) hours of practicum training and supervision 

    EXHIBIT B 

    Rules and Requirements 

    1. Rules. During the Term of this Agreement, Applicant will adhere to the following standards of conduct:

    a. Act in a manner consistent with the Training Provider’s core values of empathy, non-judgement, andrespect. 

    b. Monitor Applicant’s mental and physical health and wellbeing and take responsibility forApplicant’s self-care. 

    c. Pay careful attention to any signs in the Applicant of emotional distress, trauma symptoms,discomfort, or dysregulation and seek the help of a mental health professional if Applicant needs; 

    d. Reach out to the Training Provider’s staff if Applicant is experiencing challenges in completing A Emerald Valley Institutes Psilocybin Facilitator Training Program requirements for any reason; 

    e. Demonstrate a high level of professional etiquette and respect for professionalism during the course for instructors, speakers, and other Emerald Valley Institute Psilocybin Facilitator Training Program participants; 

    g. Create healthy spaces with appropriate boundaries in role and relationships;h. In the case of any missed learning content or in the event of any absence submit a “Leave of Absence”request to Training Provider which Training Provider may accept or reject in its sole discretion and work with Training Provider to complete an individualized education plan to ensure Applicant makes up any missed learning content, remedies any gaps in participation, and completes assignments and assessments; 

    i. Refrain from sharing or posting the Emerald Valley Institutes logo or brand identity in any way publicly and bemindful of public speech regarding the Emerald Valley Institutes Psilocybin Facilitator Training Program, and psychedelics in any form of media, including but not limited to social media or news outlets (if in doubt,Applicant may email training emeraldvalleyinstitute@gmail.com for permission); 

    j. Not attend any Emerald Valley Institute Psilocybin Facilitator Training Program sessions under the influence of any alcohol, drugs, or other awareness-altering substances. 

    k. Not market any services or products of Applicant or others to other Emerald Valley Institutes Psilocybin FacilitatorTraining Program participants 

    l. Keep the identity and personal information of any other Emerald Valley Institutes Psilocybin Facilitator TrainingProgram participants, staff members, agents, faculty, or volunteers of Training Provider confidential by refraining from using any names or other identifying information or taking any photos, videos, or audio recordings of such individuals. 

    2. Requirements. During the Term of this Agreement, Applicant must: a. Actively participate in small group integration sessions, workshops, assignments, assessments,and other coursework; 

    b. Attend a minimum of 100% of the Emerald Valley Institutes Psilocybin Facilitator Training Program (subject to aLeave of Absence request accepted by Training Provider as provided in Paragraph 1.f above); 

    c. Receive a “pass” grade on all required assignments and assessments; d. Complete the Training Program no later than two (2) years from the Start Date of their initial cohort;3. Disciplinary and Appeals Process. If Applicant fails to comply with any provision of Paragraphs 1 or 2 above or exhibits behaviors causing concern for Applicant’s ability to participate in or complete the Emerald Valley Institutes Psilocybin Facilitator Training Program:a. A notice will be sent via email to Applicant (the “Notice Email”), requesting a Zoom meeting or a written response from Applicant to the concerns expressed by the Training Provider in the Notice Email;b. Applicants must respond to the Notice Email as soon as possible, but no later than 14 days after the date of the Notice Email;c. If Applicant fails to respond to the Notice Email within 14 days after the date of the Notice Email,Training Provider may immediately expel Applicant from the Training Program.d. If Training Provider desires to have a Zoom meeting and Applicant responds to the Notice Email Within 14 days after the date of the Notice Email, the Applicant, the Director of Education, and theProgramDirector will attend a Zoom meeting to discuss the concerns expressed in the Notice Email (the“Disciplinary Meeting”);e. Following the Disciplinary Meeting, Training Provider will determine a course of action pursuant to which, in Training Provider’s sole discretion, the Applicant may be: (i) immediately expelled from theTraining program or (ii) offered a probationary period subject to specific conditions determined inTraining Provider’s sole discretion (the “Conditions”), which Conditions may include the creation of an individual education plan, and during which period Applicant may be immediately expelled from the Emerald Valley Institutes Psilocybin Facilitator Training Program if Applicant breaches any such Conditions;f. If Applicant is immediately expelled from the Training Program, Applicant may appeal the expulsion by emailing Director of Education at emeraldvalleyinstitute@gmail.com with the subject line “DisciplinaryAction Appeal” and explaining the reasons for which Applicant should not be expelled from the Emerald Valley Institutes Psilocybin Facilitator Training Program (the “Appeal Email”);g. Decisions of disciplinary decisions described in subsections e and f above will be made in writing,retained as part of the Applicant’s student file for a minimum of 3 years, and shall be made available to an Applicant, and h. Training Provider will determine the merits of the appeal and Applicant will be notified ofTraining Provider’s final decision within 10 business days of the date of the Appeal Email 

    EXHIBIT C 

    Privacy Policy Subject to any U.S. privacy laws or any other local privacy laws in Applicant’s jurisdiction,Training Provider will take reasonable steps to maintain the confidentiality of any personal information that Applicant has provided to Training Provider, including but not limited to the Original Applicant Information or New Applicant Information (“Applicant’s Personal Information”). Notwithstanding the foregoing, there is an inherent risk that electronic communications between Applicant and TrainingProvider may be unlawfully intercepted by third parties not under Training Provider’s control. TrainingProvider does not guarantee the security of any information transmitted via the Internet, telephone, text message. Applicant may authorize Training Provider to disclose any of Applicant’s information to a third party in writing signed by the Applicant.Applicant’s Personal Information will not be used by Training Provider for any purpose other than for providing Applicant with the Services specified herein without Applicant’s express written consent.Notwithstanding the foregoing, Training Provider may disclose Applicant’s Personal Information when necessary to protect the safety of Applicant or another person or as otherwise required by law, court order, or legal process, including in a response to any governmental or regulatory request. Personal Transcripts of the Applicant will be made available to the Applicant in compliance with the “FamilyEducational Rights and Privacy Act” (Public Law 93-380 as amended by Public Law 93-568).Applicant’s personally identifiable information will not be made available to anyone other than the student, Higher Education Coordinating Commission, or other local, state, or federal officials as allowed by law. Applicant’s personally identifiable information will be delivered on electronic format to theHigher Education Coordinating Commission at least once a year. Personally identifiable information of Applicant will be maintained in accordance all applicable laws, including but not limited to the OregonConsumer Identity Theft Prevention Act, ORS 646A.600 to 646A.628, and any rules adopted pursuant toORS 646A.600 to 646A.628.Training Provider will not use Applicant’s image or voice for any reason without the written consent ofApplicant; provided, however, that Applicant understands and agrees that Applicant’s image or voice from a recorded training session may be used in training materials used by Training Provider inconnection with the Program without Applicant’s written consent. 

    Agreement to Terms & Conditions

    My signature below signifies that I have read and understand all aspects of this agreement and recognize my legal responsibilities in regard to this contract and that the enrollment agreement constitutes a binding contract. I understand that I will receive an original of this signed agreement and the school will retain a copy.

    By signing below, I acknowledge that I have read, understood, and agree to the terms and conditions outlined in this agreement.

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  • Signature of Training Provider Official Date REPRESENTATIVE’S CERTIFICATION:

    I hereby certify that the participant name has been interviewed and in my judgment, meets all requirements for acceptance as a participant in A Emerald Valley Institutes Psilocybin Facilitator Training Program as described in the training catalog. I further certify that there have been no verbal or written agreements or promises other than those appearing on this agreement

  • REPRESENTATIVE’S CERTIFICATION:I hereby certify the participant has been interviewed and upon offered acceptance into the program in my judgment, meets all requirements for acceptance as a participant in A Emerald Valley Institutes Psilocybin Facilitator Training Program as described in the training catalog. I further certify that there have been no verbal or written agreements or promises other than those appearing on this agreement

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