DONATELLO SCHOOL OF NURSING AND HEALTHCARE 1414 E Semoran Blvd. Apopka FI 32703Office Ph: (407)-703-5814- Fax: (407) +703-5868donatellonursing@gmail.com ENROLLMENT AGREEMENT Step 1 of 4 25% STUDENT INFORMATIONName(Required) First Name Last Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ID or Passport #(Required)Date of Birth MM slash DD slash YYYY Email:(Required) Donatello School of Nursing and Healthcare and the student enter into agreement under which the student will pay tuition and fees as indicated below as well as adhere to the Academy's policies as set forth in the Academy catalog.PROGRAM & TUITION INFORMATIONPlease check the box below for your program of choice:Program Home Health Aide Practical Nursing Credential Diploma Diploma Credit?Clock Hours 75 Clock Hours 1371 Clock Hours OFFICE USE ONLYStudent Start Date MM slash DD slash YYYY Anticipated Program Completion Date MM slash DD slash YYYY Name of Credential to be awarded: Length Expected Total Program Cost: Clock Hours Monday Day Evening Tuesday Day Evening Wednesday Day Evening Thursday Day Evening Friday Day Evening Saturday Day Evening HOME HEALTH AIDE ADMISSION REQUEREMENTS The following admission requrements must be met in order for an applicant to be eligible for admission to programs at the Donatello School of Nursing and Healthcare. The applicant must be 18 years of age. If the applicant is less than 18 years of age, a parent/guardian signature is required to enroll the student in program The applicant for admission should be submitted to the Administration Office prior to the beginning of the dates of enrollment. A $75.00 not-refundable registration fee is charged for processing a student's first application. Submit a completed application for admission with a registration fee fo $75.00. Applicants must present a Valid picture ID. Applicants must present a High School diploma or GED. Complete an in-person interview with Donatello School of Nursing and Healthcare representative. The prospective student must have desire to succeed in the chosen program of study, a willingness to make the sacrifices necessary to succeed in higher-level study, and a commitment to adhere regulations, and rules within the handbook. Background Check- Level II- Original Report (fingerprint card is or authorization number for electronic fingerprinting must be obtained from Donatello School of Nursing Healthcare prior start of program to prevent rejection, and or refusal for examination of a certifying or licensing entity to a student. Student is responsible for paying for background.) PRACTICAL NURSING ADMISSION REQUIREMENTS The following admission requirements must be met in order for an applicant to be eligible for admission to programs at the Donatello School of Nursing and Healthcare: Complete an application with Donatello School of Nursing and Healthcare representative. Submit a signed Enrollment Agreement. The applicant must be 18 years of age. If the applicant is less than 18 years of age, a parent/guardian signature is required to enroll the student in program. Payment of one-time, not-refundable registration fee of $150.00 An applicant must have the available to attend all classes, clinical/externships, and to submit all assignments, and projects promtly. Students are expected to have the time to devote to studying outside of class. Background Check -Level II - Original Report (fingerprint cards or authorization number for electronic fingerprinting must be obtained from Donatello School of Nursing and Healthcare. Complete an in-person interview with Donatello School of Nursing and Healthcare representative. Copy of state ID or Driver's License Social Security Card/Tmmigration documents Interest/Professional Attitude: The prostective student must have desire to succeed in the chosen program of study, a willingness to make the sacrifices necessary to succeed in higher-level study, and a commitment to adhere regulations, and rules within the handbook. Entrance Evaluation - TEAS: Prospective students must demonstrate the ability to succeed in higher-level education through an entrance exam evaluation test (TEAS) that includes a basic Home Care, Nursing Assistant, Medical Administrative, and Professional Workplace. A minimum acceptable score of 50% must be achievied. If the student's score is below the necessary level, for their chosen program of study, remdiation will be arranged at a determined cost based on the remediation clock hours needed for the anticipated program if accepted. For applicants, without an HSD or GED, a Test of Basic Education with a minimum score for program enrolled needs to be achieved TABE grade levels required: Home Health Aide - 7th | Practical Nursing - 11th. Notarized Education Verification form with name and place of the school attended if unable to get an original copy The school will accept an official TEAS test score from an approved School taken within 6 months of the anticipated enrollment date. Curren standard First Aid and CPR/AED for healthcare providers before acceptance, or before the Core Course is completed. Upon acceptance the following documents are needed: Health History and Physical - Original Report Tuberculin Test - Original Report or Chest X-ray if from a foreign country or known to be once exposed the applicant will need the 2 steps Tuberculin Skin Test or chest x-ray report from a physician. Tetanus, Measles, Mumps, Rubella, shot record is acceptable. Hepatitis B (A copy will be accepted.) This test is not mendatory. Criminal Background Checks: Donatello School of Nursing and Healthcare will ask if you have ever been convicted of any crime that may or may not affect your eligibility. Students enrolled in any program offered will be asked to conduct a level II background check, and or a drug test to complete their clinical hours at hospitals or other medical facilities. Please be advised that some of the examining agencies for Certification and licensing may inquire concerning a person's criminal background, and a Level II report may be needed. The school is not responsible for the rejection, and or refusal for an examination of certifying or licensing entity to a student. Florida Board of Nursing Disclaimer: Acceptance into the institution does not imply acceptance into any offered program. Students may not be accepted into a program if your FDLE (Level II) background check shows evidence that would prevent them from taking your state exam. The Florida Board of nursing, following the Rules and Regulations of the Nurse Practice Act, will determine if a nursing program graduate is eligible for licensure when there is no arrest/ conviction record. All individuals with a criminal or discipline history should read Chapter 464, Florida Statutes (F.S), and Chapter 64B9, Florida Administrative Code (F.A.C) as they pertian to the practice of nursing. The Board of Nursing encourages all individuals with a criminal or disciplinary.TUTION & FEES Program Credit/ Clock Hours Tuition Registration Fee** Books & Supplies Other Fees Total Cost Home Health Aide 75 Clock Hours $475.00 $75.00 $110.00 - 660.00 Practical Nursing 1351 Clock Hours $15000.00 $150.00 - $150.00 15300.00 Books and Supplies are not included in the tuition for Practical Nursing and is estimated as follow: Practical Nursing: $2000.00 - $2500.00.**NON-REFUNDABLE: Registration fee is not-refundable. Costs assessed for book, supplies and materials which are not returnable because of use are non-refundable.Itemization of additional costs a student could expect to incur:PAYMENT OPTIONS METHODS OF PAYMENT (choose one) As started on the Enrollment Agreement, students may select to make payments as follows: Untitled(Required) Full payment at time of signing enrollment agreement Registration free at the time of signing enrollment agreement with balance paid prior starting date. Registration free at the time of signing enrollment agreement with balance paid prior to graduation by a payment plan. NOTE: If four or more payments, complete the federal boxes bellowAMOUNT FINANCED (The dollar amount the credit provided to you or on your behalf.) FINANCE CHARGE TOTAL OF PAYMENT(The amount you will have made all payments as scheduled.) TOTAL SALES PRICE (The total cost of your purchase on credit including your down payment of $______) YOUR PAYMENT SCHEDULE WILL BE:NUMBER OF PAYMENTS(Required)AMOUNT OF EACH PAYMENTS(Required)WHEN PAYMENTS ARE DUE(Required)Beginning on ____/____/____ and on the same day each. week biweekly month A late fee of $30 applies All prices for program are printed herein. Contracts are not sold to a third party at any time. There are no carrying charges, interest charges, or service charges connected or charged with any of these programs unless stated.CANCELLATION AND REFUND POLICY When a student enrolls in a program of study, he has reserved a place that cannot be made available to other students. The Enrollment Agreement constitutes a biding contract once it has been signed by the student and institution's official. Should a student's enrollment be terminated or cancelled for any reason after class start, all refunds will be made according to the following refund policy: Cancellation must be made in person or by certified mail/ All monies will be refunded if the school does not accept the applicant or if the student cancels within three (3) business days after signing the Student Enrollment Agreement an making initial payment. Cancellation after the 3rd business day, but before the first class, will result in a refund of all monies paid, with the exception of the registration fee (not to exceed $150.00). Cancellation after attendance has begun, but up to and including 40% completion of the program, will result in a pro rata refund computed on the number of hours completed to the total program hours. Cancellation after completing 41% of the program will result in no refund. Termination Date: The Termination date for refund computation purposed is the last date of actual attendance by the student unless earlier written notice is received. Refunds will be made within 30 days of termination or receipt of Cancellation Notice. Cancellation of classes by the institution after attendance has begun will result in 100 percent refund. Should the prospective student not meet the entrance requirements it will result in 100 percent refund, of applicable. GRADUATION REQUIREMENTS: A Diploma is presented to the student who has: Successfully completed all required course competencies of the enrolled program. Completed attendance requirements. Met satisfactory academic progress. Fulfilled all monetary obligations to Donatello School of Nursing and Healthcare. GROUNDS FOR TERMINATION: A student's enrollment can be terminated at the discretion of the institution for insufficient academic progress, non- payment of academic costs, or failure to comply with rules and policies established by the institution as outlined in the catalog and this agreement.EMPLOYMENT ASSISTANCE: Students are assisted with placement and furnished names and addresses of employment possibilities. Inquiries made to the school from potential employers will b shared with students. The Admissions staff of Donatello School of Nursing and Healthcare will assist the student with employment to the best of its ability but cannot guarantee employment. Although the school cannot guarantee employment or placement, reasonable efforts will made to assist students in securing suitable employment. This assistance is free and available to any student, regardless of when the student graduated.READ, SIGN AND DATE: DO NOT SIGN THIS CONTRACT BEFORE YOU HAVE READ IT OR IF IT CONTAINS ANY BLANK SPACES. ALL SIGNERS HAVE RECEIVED AND READ A COPY OF THE BIDDING DOCUMENT AND CATALOG.Students' Signature(Required)Date(Required) MM slash DD slash YYYY Parent or Guardian Signature:(If student is under 18 years of age)Date MM slash DD slash YYYY School Official Signature:(Required)Date(Required) MM slash DD slash YYYY Section BreakStudent Name(Required) TUBERCULOSIS SKIN TEST FORMHealthcare Professional/ Patient Name Testing Location: Date Placed: MM slash DD slash YYYY Site:RightLeftLot#:Expiration Date:(Required) MM slash DD slash YYYY Signature (Administered by):(Required)UntitledRN__MD__Others___________Date Read (within 48-72 hours from date placed): MM slash DD slash YYYY Induration (please note in mm): PPD (Mantoux) Test ResultNegativePositiveSignature (results read/reported by):UntitledRN__MDOtherSection BreakPHYSICIAN'S STATEMENTEmployee/ApplicantName:(Required) First Last Four Social Security Number:To be completed by Physician I have examined the individual named above and to the best of my knowledge he/she is good physical and mental health, free of any communicable diseases, and is able to function in his/her profession at full capacity. By signing below I certify that the above information is trueName(Required) First Title (Must Circle One): MD DO NP PA APN APRN Physician Signature:Office Phone NumberDate of Exam MM slash DD slash YYYY Address Street Address Address Line 2 Office Stamp