SECTION 1 I APPLICANT INFORMATION:

By signing this Connecticut Health Career Institute (CHCI) application, I acknowledge and agree with the statements set forth below:

• I give CHCI permission to contact me at the phone numbers I have provided via any means, including text message or voice. (Students may optout by contacting CHCI)
• I give permission for my likeness, voice, or comments to be used in any promotional item on behalf of CHCI.
• I understand CHCI is not liable for any emergency medical attention provided or for charges incurred from such.
• I agree to abide by the policies and procedures set forth in the CHCI Student catalog.
• I understand all materials submitted for application become the property of CHCI and will not be returned to the applicant.
• I certify the information contained in the application is complete and accurate; making a false statement on this application may result in my dismissal from CHCI.
• I understand I must render a non-refundable $150 registration fee & a non-refundable $25 application fee.
• I understand that checks returned for insufficient funds (NSF) will incur a $35 fee, or as charged by CHCI's financial institution. Additional fees apply for failure to pay within 30 days.
• I understand this application is not a guarantee of admission to the program and that I must still complete an interview and enrollment agreement before admission.

Course cost is outlined below:

	Certified Nurse's Aide	Certified Phlebotomy Technician	Patient Care Technician
Tuition:	$1,150	$1,250	$3,985
Application Fee (Non-refundable):	$25	$25	$25
Registration Fee (Non-refundable):	$150	$150	$150
Kit, Books & Supplies	$150	$150	$450
Total Cost:	$1,475	$1,575	$4,610

The $175 Application and Registration Fee, at a minimum, is required to reserve their seat in the course. If a student opts to use the 3-month payment plan, the remaining balance will be divided into three monthly payments. The first payment is due on the first day of the scheduled course.

Please Note: All balances must be paid in full, or arrangements have been made to pay outstanding balances for a student to receive their certificate.

Payment can be made in the form of cash, check, money order, or credit card.

I agree that the balance due for Tuition & Fees will be made as detailed above. Students who are delinquent on their scheduled payments will receive a notice of their account, reminding them that a payment is due. If payment is not received within 7 days of the original notice, a second notice will be sent. Failure to pay 14 days after the initial notice is sent may result in a student being suspended or terminated. If a student is suspended, the student may reapply for admission after their account has been reconciled. Students will not receive any certificates of completion or transcripts until all outstanding debts to the school have been paid. Information on refunds, cancellations and withdrawals can be found in the school catalog.

Grounds for Termination:

Students must comply with the policies within this enrollment agreement. Adherence to the Students Code of Conduct & Attendance Policies will be strictly enforced. Failure to comply may result in termination by the Campus Director with 0 (zero) refunds. CHCI reserves the right to dismiss any student for:

1. Failure to meet financial obligations.

2. Failure to meet attendance and grade requirements.

3. Failure to comply with the Student Code of Conduct and School Policies.

Make up time and extended program hours are subject to availability.

CANCELLATION / DELAYS

Connecticut Health Career Institute (CHCI) reserves the right to cancel a scheduled program at any time. If classes are canceled or delayed prior to a scheduled start date, the student will have the option of accepting the delay and joining the next scheduled start date or requesting a full refund of all monies paid, including the non-refundable application fee. Upon 2 (two) consecutive calendar days of absence at the start of a class a student's enrollment may be terminated with no refunds or rescheduled for the next available class start.

WITHDRAWAL BY STUDENT

Students may withdraw from their program at any time but are not guaranteed to receive any tuition reimbursement that this will be in conformance with the Refund Policy below).

REFUND POLICY

A student (or legal guardian) cancels his/her enrollment within three business days of signing the enrollment agreement. All monies other than the non- refundable application and registration fees collected by the school shall be refunded, regardless of whether the student has actually started classes.

Once class has begun there is no tuition refund.

Refundable tuition is defined as the total excluding the Non-Refundable Application and Registration Fee. An applicant rejected by the school is entitled to a refund of all tuition paid. To receive a tuition refund, a student should contact Connecticut Health Career Institute (CHCI) during business hours either by phone, in-person or via mail and notify the Director of the withdrawal. Tuition refund calculation shall be based on the last verifiable date of attendance. Connecticut Health Career Institute (CHCI) will mail the requested tuition refund within 30 days from the last verifiable date of attendance.

METHOD OF PAYMENT

Connecticut Health Career Institute accepts cash, check, money order or credit card for program fees. Tuition is due based on the terms in the student enrollment agreement and/or any supplemental payment plan agreed to during the admissions interview. Payment of the total program cost (tuition, registration, supplies, and textbooks) may be made in accordance with one of the following: 1. Advance Payment in Full - A student may elect to pay the full program cost prior to the start date of the program. No interest will be charged. 2. Installment Payments - A student may make a down payment of 25% of the program cost prior to the start date of the program and then make equal monthly installment payments, as stated in the payment agreement. All payments are expected in accordance with the agreed upon payment.

INSUFFICIENT FUNDS POLICY

Checks returned for insufficient funds (NSF) will incur a $35 fee, or as charged by CHCI's financial institution. Failure to pay the fee within 30 (thirty) days may result in additional interest fees.

COLLECTIONS

Students in default of monthly payments may be sent to a Collection Agency. In accordance with the terms of their enrollment agreement, interest and/or collection fees may be added to the balance owed.

National Health Career Association Testing

Phlebotomists and Patient Care Technicians are eligible to take certification examinations through the National Health Career Association upon completion and graduation of their program. The student must pass a written test. In addition, applicants must submit proof of their Phlebotomy Draws for certification. Contact information for the National Health Career Association is as follows: National Health Career Association

Prometric Testing

Nurse Aide Students are eligible to take a certification examination through Prometric Testing upon completion and graduation of their program. The student must pass a written and clinical skills test. (given only in English) Testing requirements can be found at www.prometric.com/NurseAide/CT Contact information for Prometric is as follows:

Prometric CT Nurse Aide, 941 Corporate Drive., Nottingham, MD 21236, Phone: (866) 499-7485, website: ctcna@prometric.com

 

GRADUATION & PLACEMENT REQUIREMENTS:

Students enrolled are awarded a certificate of completion contingent upon successful completion of all program and graduation requirements. Program and graduation requirements are as follows:

1. Minimum 80% grade point average and successful completion of clinical rotation

2. Successful completion of all program courses (i.e., students who receive a subject grade below a 60 for any subject must repeat and pass the applicable subject).

3. Fulfillment of financial obligations to the school or arrangements has been made with the school administrator for repayment of any balance owed to the school.

4. Completion of required hours and successful completion of registration for testing with respective agency.

5. CHCI does not guarantee employment after graduation. We do, however, provide assistance to all our graduates who request help in seeking employment.

Please note, employment barriers such as a criminal conviction, may prevent employment in some medical facilities. Most healthcare job openings may require a high school diploma/GED and/or specific medical clearances, including but not limited to, physical limitations, covid vaccinations, etc.

ACKNOWLEDGEMENT

I have received, read, and understand on ___________________prior to entering an enrollment agreement, the following information to include cost of program, length of time for graduation, grounds for termination, refund policy, cancellation policy, and have received a copy of the school catalog. This contract contains the entire agreement between the school and myself and no further modification of representation except as herein expressed in writing will be recognized. This contract continues a binding agreement upon acceptance of the school.

The student has received and read a copy of the student handbook and school catalog and (a) agrees to abide by the rules and policies of Connecticut Health Career Institute during his/her period of attendance; (b) understands that excessive absences, non-payment of tuition, failing grades, or unsatisfactory conduct may result in immediate dismissal(refer to current school catalog); (c) agrees to make tuition payments as specified in this agreement with the understanding that absence from regularly scheduled classes does not relieve him/her of this liability; and (d) understands they may withdraw at any time, but are not guaranteed to receive a tuition refund.

Complaint Procedure: Please refer to the School Catalog for information regarding the school's full complaint procedure. You may also contact the Campus Director at 203-549-1135. Questions or concerns that are not satisfactorily resolved by the person designated above or by other school officials may be brought to the attention of the Connecticut Office of Higher Education, 450 Columbus Blvd, Suite 707 Hartford, CT 06103-1841, or ct.gov/StudentComplaint.

I have read and understand all the information contained within this contract and I have also received a copy of this signed document and a copy of the School Catalog.

School Official's Signature* *This agreement is not binding until the date signed by the School Official

Please call the office (203) 942-2505, if you have a disability that may require you to receive special assistance to complete the application. Connecticut Health Career Institute (CHCI) does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, genetic information, disabled veteran, veteran of the Vietnam Era, or citizenship status (except in those special circumstances permitted or andated by law).

A.  In consideration for educational services, I promise to pay, per the terms of this agreement, the Principal Amount representing the amount of credit provided to me or on my behalf by Connecticut Health Career Institute.

B.  I will make payments in person or by mail to CHCI, at 457 N Main St., Suite 3C, Danbury, CT 06811, as follows:

Thereafter, each payment will be made on the same day of the month as the initial payment due date indicated, and in accordance with the payment frequency stated above. My payments will be applied first to late charges and the remainder to the principal. To the extent permitted by applicable law, the institution may accept late payments, partial payments or payments marked "payment in full" or having similar language, without waiving its rights.

DISCLOSURE STATEMENT

C. TOTAL OF PAYMENTS.

The total of payments the borrower will have paid after all scheduled payments have been made is $__________.

D. RIGHT TO REPAY.

I have the right to prepay all or any part of the outstanding balance at any time without penalty.

E. COLLECTION FEES.

If my account is in default and referred to a collection agency or an outside attorney to collect the outstanding debt, I will pay the costs of collection, including reasonable attorney fees to the extent permitted by state law.

F. OBLIGATION AND ACKNOWLEDGMENT OF STUDENT.

I agree to make all scheduled payments. I agree that my enrollment at the Institution is contingent upon maintaining a current account and that, in addition to the above remedies for default, if I fail to make my scheduled payment, the Institution may deny access to classes, final exams, or any other institution service. In addition, the Institution can discontinue a student's enrollment status, not issue grades, and deny requests for transcripts should a student not meet all his/her financial and institutional obligations.

G. DISHONORED PAYMENTS:

If a payment by check or draft is not honored by the drawee, then I will be charged a fee up to $25.00 to the extent permitted by state law.

NOTICE TO BORROWER:

(1) Do not sign this agreement before you read it or if it contains any blank spaces to be filled in. (2) You are entitled to a completed copy of this agreement. (3) You can prepay the full amount due under this agreement at any time. (4) If you desire to pay off in advance the full amount due, the amount which is outstanding will be furnished upon request.

NOTICE TO APPLICANTS AND STUDENTS

Connecticut Health Career Institute does not discriminate on the basis of disability in its programs and activities in violation of Section 504 of the Rehabilitation Act, as amended and the implementing regulations (Section 504 Programs and activities subject to the nondiscrimination provisions of Section 504 include admissions and recruitment, treatment of students, academic adjustments (academic requirements, course examinations, and auxiliary aids), financial and employment assistance to students, and nonacademic services. The person responsible for coordinating our efforts to comply with Section 504 is Audrey Powell, 457 North Main Street Suite 3C, Danbury CT 06811 email: audrey@cthealthcareer.training. He/she is also the person responsible for (1) explaining to applicants and students how to obtain information about the process to secure academic adjustments and (2) receiving requests for academic adjustments.

Please be advised that if you have been convicted of a felony, you may not be eligible for certain clinical experiences, associated with our educational programs. Those with non - felonious criminal backgrounds may also find it difficult to secure employment within a health care setting.

Please note, employment barriers such a criminal conviction may prevent employment in some medical facilities. Health care job openings may require a high school diploma/GED and/or specific medical clearances for employment.

The school reserves the right to reject applicants on the basis of a personal interview.

By signing this document, I am stating the I fully understand the consequences related to felonies and other statements contained in this document.

I have applied for admission as a student at Connecticut Health Career Institute. 

I understand that graduation from high school, or its equivalency, is one requirement for admission to Connecticut Health Career Institute's Certified Phlebotomy Technician and Patient Care Technician programs.

If for any reason, this attestation of high school graduation or GED completion is found to be false or untrue, I understand that I will not have met an admission requirement of Connecticut Health Career Institute and I will not be considered a regular student and thus, will be subject to immediate dismissal from Connecticut Health Career Institute.

Furthermore, I understand that if this attestation is found to be false or untrue, any state or institutional financial aid that was distributed on my behalf must be refunded to the appropriate source, and that I will be responsible for payment to Connecticut Health Career Institute for any and all money refunded.

By my signature below, I attest that the information provided above is true and correct to the best of my knowledge.