Application/ Enrollment Agreement

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Please read all the information in the Student catalog/handbook and application carefully. Before filling out the application, the applicant is required to meet with the Director of Education and the Registrar to discuss the parameters of the program.

General Information


(If current address is less then one year complete previous address)

(Please choose one)

Emergency Contact

Please include Emergency Contact information.

High School Information

Medical Skills for Life Institute will attempt to contact your high school to obtain proof of your ability to benefit from the course I authorize Medical Skills for Life Institute to obtain a copy of my high school transcripts:

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By signing below student hereby authorizes the institution named above to release their academic transcripts to Medical Skills for Life Institute

Credit For Previous Training


Medical Assistant Program Information

Entry-level competencies for the medical assistant certificate program include, but are not limited to:

Administrative Medical Assistant: perform clerical functions of all aspects in the medical office, bookkeeping procedures, transcription, process Insurance claims and patient billing and collections

Clinical Medical Assistant: Perform patient Care techniques; administer medication, laboratory specimen collection, diagnostic procedures and all fundamental procedures of the back office

Phlebotomist/Laboratory Assistant: Draws blood collects laboratory specimens and Assist with Laboratory Procedures

Financial Aid Institution

Student will receive the provisions from the outside lending institution CREDIT FOR PREVIOUS TRAINING IS NON-APPLICABLE!

General Expectations


• All students are expected to appear neat, freshly clean, groomed and appropriately attired in the classroom, clinic and at all student functions and activities. Sloppiness, slovenliness, and lack of grooming are unacceptable.

• All students are expected to conduct themselves in an appropriate manner and demonstrate qualities reflecting a professional-in-training. These qualities include honesty, self-responsibility, consideration for others and mature judgment, common courtesy to others and be cooperative with faculty and staff.

• All students are expected to have a desire to become competent professionals and have a positive attitude toward the profession.

• All students are expected to participate in class discussions, class activities, (examples are participating in Mock Clinics and guest speaker lectures), public relations such as health fairs, and other activities which may occur outside traditional school week hours designated by the program administration that are beneficial to students.

• All students are expected to attend tutoring classes if academic grades fall below a ‘C’ average.

• All students eligible to graduate are expected to participate in graduation ceremonies.

• All students are expected to know and follow the policies in the catalog/student handbook.

(Please initial here)

Refund Policy


NRS 394.449 Requirements of policy for refunds by institutions

1. Each postsecondary educational institution shall have a policy for refunds, which at least provides: (a) That if the institution has substantially failed to furnish the training program agreed upon in the enrollment agreement, the institution shall refund to a student all the money he has paid.
(b) That if a student cancels his enrollment before the start of the training program, the institution shall refund to the student all the money he has paid, minus 10 percent of the tuition agreed upon in the enrollment agreement or $100, whichever is less.
(c) That if a student withdraws or is expelled by the institution after the start of the training program and before the completion of more than 60 percent of the program, the institution shall refund to the student a pro rata amount of the tuition agreed upon in the enrollment agreement, minus 10 percent of the tuition agreed upon in the enrollment agreement or $100, whichever is less.
(d) That if a student withdraws or is expelled by the institution after completion of more than 60 percent of the training program, the institution is not required to refund the student any money and may charge the student the entire cost of the tuition agreed upon in the enrollment agreement.

2. If a refund is owed pursuant to subsection 1, the institution shall pay the refund to the person or entity who paid the tuition within 15 calendar days after the:
(a) Date of cancellation by a student of his enrollment;
(b) Date of termination by the institution of the enrollment of a student;
(c) Last day of an authorized leave of absence if a student fails to return after the period of authorized absence; or
(d) Last day of attendance of a student, whichever is applicable.

3. Books, educational supplies or equipment for individual use are not included in the policy for refund required by subsection 1, and a separate refund must be paid by the institution to the student if those items were not used by the student. Disputes must be resolved by the Administrator for refunds required by this subsection on a case-by-case basis.

4. for the purposes of this section:
(a) The period of a student’s attendance must be measured from the first day of instruction as set forth in the enrollment agreement through the student’s last day of actual attendance, regardless of absences.
(b) The period of time for a training program is the period set forth in the enrollment agreement.
(c) Tuition must be calculated using the tuition and fees set forth in the enrollment agreement and do not include books, educational supplies, or equipment that is listed separately from the tuition and fees.

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References


Examples of References(s)
List names, titles, addresses, phone numbers and e-mail addresses of three people that you will use as a reference. Preferably school teachers, present or former employer, peer person and one adult (other than parent or sibling).

Enrollment Questionnaire


The enrollment questionnaire is intended to assist in the admission process. Our goal is to enroll students that characterize maturity, ambition and self-esteem.

Enrollment Agreement


This Enrollment agreement and Student Catalog/Handbook shall apply as a legally binding contract made between Student and Medical Skills for Life Institute

The person signing the enrollment agreement has received and read a copy of Catalog/Student handbook and the enrollment application, which will act as the binding document and understands all components, are part of the enrollment agreement.
I attest that I have read this agreement, and my signature is given below:

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IMPORTANT: The student will be required to and agree to be governed by these policies for as long as he/she is enrolled

Medical Skills For Life Institute
3110 S Rainbow Blvd
Suite #104
Las Vegas, NV 89146
Telephone: (702) 645-7900

Statement Of General Health


To the best of my knowledge, I do not have any known physical or emotional problems that might negatively affect my progress in my educational program or participation in clinical or extern activities, both as a student and upon graduation.

DISABILITY SERVICES STUDENT INTAKE FORM

This form is to be completed by the student only. If the student requires assistance, please seek the help of one of the Directors of Medical Skills for Life (Eligah Nesmith or Valerie Nesmith), your student ombudsman, or your Faculty ombudsman. Fill out the form as completely as you can, and provide the required documentation as soon as possible. All information is confidential

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Required Documentation: You are required to present a recent letter, on official letterhead from a pertinent professional, containing a clear statement regarding your disability, and/or need for accommodation. You should do so as quickly as possible. Failure to provide adequate or appropriate documentation within a reasonable time to substantiate your disability and/or need for an accommodation, any accommodation granted to you may be removed. My signature below affirms that I am seeking a reasonable accommodation of my disability (or disabilities) as a student at Medical Skills for Life, and for no other purpose. I attest that every part of this application is true, and that any documentation that I present in support of this application is true, to the best of my knowledge and belief. By signing below, I understand that despite my disability, I must meet the minimum standards as set forth by my program of study and the classes I take with or without accommodations; I am responsible for following the school’s policies and code of conduct found in the school and online. I also understand that it is my responsibility to communicate with my instructor concerning my accommodation(s), where necessary or called for, to help ensure that there are no gaps in my instruction, and that I am being accommodated, where appropriate. I acknowledge that as a student it is my responsibility to let my instructor and/or the Directors of Medical Skills for Life know if I have any concerns or problems with my accommodation.

Assessment Of Ability To Benefit


(Please check one)

List any physical limitations that may hinder successful completion of course work and subsequent employment in chosen field.

List prior experience or education that will aid the student in his/her chosen field.

State specific areas of deficiency requiring remedial work

List the courses and specific level of competency to be attained and required by date of completion.

Friends Helping Friends


Our school’s “Friends Helping Friends” program is designed for our students who care about helping their friends or relatives who may:

1. Not be satisfied with their current job
2. Have no opportunity for advancement
3. No longer be able to work in their current job
4 .Not be earning enough money

I would like the following individuals to receive career training information from our school

Signature