SIAHT Enrollment Agreement for Programs

“Enrollment Agreement” means any agreement or instrument, that creates or evidences an obligation binding a student to purchase a program of study or course offering from our institution. Enrollment Agreements provide with requirements for retention, progress towards credential, and completion by the student; our institution’s tuition, cancellation and refund policies; and a statement of purpose and amount of any fees assessed. Once student fills out the registration form they are required to complete the Online Enrollment Agreement form.

Student Full Name *

First Name Last Name

Social Security Number *

Student ID Number

Student Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Student E-mail *

Student Mobile Number *

Student Phone Number *

Area Code Phone Number

Emergency Contact Name *

First Name Last Name

Emergency Contact Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Emergency Contact Phone Number *

Area Code Phone Number

Emergency Contact Email: *

example@example.com

Relationship to Student *

What is your relationship to the Emergency contact person name you provided.

Please Select ONLY one of the following programs: *

A- Personal Fitness Trainer (PFT)- 40 weeks (31 credit hours/ 460 clock hours) online LMS Mon-Sun B- Nutrition Wellness Coach (NS)-40 weeks (35 credit hours/420 clock hours) online LMS Mon-Sun C- Medical Billing and Insurance Specialist (MBIS)-40 weeks (34 credit hours/420 clock hours) Online LMS Mon-Sun D- Pharmacy Technician Program (PT)-40 weeks (37.5 credit hours/560 clock hours) Online LMS Mon-Sun E- Neurophysiology Technician (NT)-40-60 weeks totals, 36 weeks lecture (30 credit hours/480 clock hours) Online LMS Mon-Sun

Start Date of the Program:

Start and End time of Classes:

Term entering in the Program:

Spring Term Summer Term Fall Term Winter Term

Program Accessibility:

Full time accessible on LMS Part time accessible on LMS

A.Tuition Refund Policy: If a student decides to drop out of the program, he/she will need to follow the following guidelines:

Once the program has started and student has enrolled in the LMS, student can drop out of the program and receive 100% refund till 5th business day.
After 5 business days if student decides to drop out of the program, he/she will received 50% refund.
Student will receive 25% of refund after 10 days business days have passed.
After 10 business days student decides to drop out of the program, they will receive 0% refund.
After 10th business day the student owes tuition to school if they consider dropping out .
In case if student has not made any payment from the tuition plan provided to them within 5 business days of starting the program, school doesn't owe anything to the student .

B.Tuition Information:

Depending on your program the tuition for program is as follows. This gives a breakdown of what is included in the tuition.

Personal Fitness Trainer Program:

Tuition: $3000.00
Registration Fees: $40.00
Books and Supplies: $1,010

Included in the tuition are books and certification fees including CPR and NAFC certification fees:

Books: $600.00
Certification fees: $400.00
CPR certification fees: $40.00
Uniform for student: $50.00

Nutrition Wellness Coach Program:

Tuition: $2800.00
Registration Fees: $40.00
Books and supplies: $940.00

Included in the tution are books and CPR certification fees and NAFC certification fees:

Books: $500.00
Certification Fees: $400.00
CPR certification fees: $40.00

Medical Billing and Insurance Specialist Program:

Tuition: $4500.00
Registration Fees: $40.00
Books and supplies: $1217.00

Included in the tuition are books and AHIMA/NCCT certification fees:

Books: $800.00
Certification Fees:$300.00
Membership fees: $77.00

Pharmacy Technician Program:

Tuition: $4000.00
Registration Fees: $40.00
Books and supplies: $1140.00

Included in the tuition are books, PTCB certification fees, CPR Certification fees, background check fees and licensing fees.

Books: $800.00
Licensing fees: $100.00
Certification fees: $200.00
CPR Certification fees: $40.00
Background check fees: $30.00

Neurophysiology Technician Program:

Tuition: $5000.00
Registration Fees: $40.00
Books and supplies: $950.00

Included in the tuition are books and certification fees

Books: $200
Certification Fees: $700

The information is also provided in the student handbook that student receives upon admission and is accessible to anyone on the website: https://www.siaht.org/

C. Communications Policy: Skokie institute classes for the students are online. Students are required to register and log into their classroom after they are provided with the access code by the instructor or Executive Director/Dean. Students will be allowed 3 days to register. If a student doesn’t register within 3 days of the scheduled start date and time they will be automatically considered dropped from the program.

Since the programs are online, the institution will contact the student via email. The student is required to respond back. Once the student is registered and they fail to communicate with the instructor/administration when contacted. The institution will drop the student after 3 failed attempts.

Students need to inform the Executive Director/Academic Dean/Instructor if they were not able to log into their classroom within the scheduled start time and day or regarding any issues that may hinder their learning process.

D. Student Online Learning Management System (LMS): Skokie Institute of Allied Health and Technology (SIAHT) believes in providing our students with an online learning management system, that makes it interactive and gives them an experience of real classroom. Due to this SIAHT uses Schoology. A learning management system that presents a unique opportunity for us to enhance our students’ learning experience to facilitate their success. Students provide an email to the academics’ department once they are registered for their courses. Once classes start the instructor sends them an access code. Student goes on: https://www.schoology.com/higher-ed and sign up as a “student”. The site prompts student to enter the access code and then asks for them to create a login and password. Student then is prompted to SIAHT courses and they join the course.

The instructor receives an email that let her/him know that student has joined the course. Student can then look at the assignments due dates, submit assignments and email instructor. The student must login to Schoology once every day after registration. The student is only required to login once every day for 1 week after registering for the course.

E.Cancellation Policy: The student has a right to cancel the program and receive refund, according to the guidelines in the Tuition Refund Policy. If they don't contact the Executive Director, student is then considered dropped after 5th business day with the amount owe to school. Student has to email the Executive Director or Academic Dean, at bkhizer@siaht.org or belashoab@gmail.com or they can come in person to cancel the program at the head office at: 2700 Patriot Blvd, Suite 250, Glenview, IL 60026. Student can fill out the seperate "Drop form" found on the website.

F.Withdrawal Policy: The student is considered a drop if he/she has been assigned a login code and has not logged into their classes within 3 business days. The student can email to the Executive Director or Academic Dean at: bkhizer@siaht.org or belashoab@gmail.com if they would like to drop from the program.

G.Institutional Disclosure Statement: The institutional Disclosure statement provides the students with the information they need regarding their program of interest. The disclosures give students information regarding enrollment, graduation as well as students working in the field. The student disclosures are for year 2017 and the year 2016 can be found on the website.

H. SIAHT Privacy Policy: SIAHT has a disclosed privacy policy that ensures that students' private personal information is protected. The policy is present on our website: https://www.siaht.org/

I.Payments and Interests On Tuition: Skokie Institute of Allied Health and Technology is currently in the process of achieving accreditation for programs to be qualified through financial aid. Skokie Institute of Allied Health and Technology doesn't charge interest, or late fees to students making payments. Students are provided with a tuition plan after the discussion with Executive Director. It is the student's responsibility to inform the school of any changes in the set tuition plan, if the student doens't inform the school and fails to follow the tuition plan, students are charged 2% tuition interest before they graduate from the program.

SIAHT is approved via WIOA to offer free program for MBIS, PT and NT.

CLIMB Credit offers student loans for programs. Students can apply for tuition loans at: https://www.climbcredit.com/siaht/

WIOA grants are available for allied health programs. The students approved through WIOA receive full benefit of free training.

J. Student Handbook: The student handbook is available to students via our website https://www.siaht.org/ . The Handbook is updated every year and any new updates to the handbook is emailed to students while they are still enrolled in the program.

NOTICE TO STUDENT

Do not sign this agreement before you have read it or if it contains any blank spaces.

This agreement is a legally binding instrument and is only binding when the agreement is accepted, signed, and dated by the authorized official 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 an exact 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.

Section Ka and Kb are for students who are enrolling in: Pharmacy Technician or Neurology Technician Program. Please proceed to answer only if you are enrolling in any of these programs. The institution would like the students to be fully aware of the following conditions regarding these two programs.

If you are not enrolling in any of these two programs then please proceed to sections K and forth.

Ka. Only proceed to answer this question if you are enrolling in SIAHT Pharmacy Technician Program. SIAHT requires it's Pharmacy Technician students to have a background check before students can start their classes in the program. The requirement follows the guidelines for Walgreens which is SIAHT's preferred site. I understand that I will need to go through a background check and my admission in the program is contingent on clearing the background check.

Yes. I allow the school to go through the background check No. I don't agree and would like to discuss the background check option

Kb. Only proceed to answer this question if you are enrolling in SIAHT Neurology Technician Program. SIAHT requires it's Neurology Student to secure their own clinical site to complete 140 hours of clinicals that are 12 weeks long and proceed to 2 terms, before student is able to graduate and sit for the ABRET CNIM exam. The institution will help the student in securing and filling out the necessary paperwork to complete the clinicals.

Yes. I understand that I will need to secure my own clinical site . No. I don't feel comfortable in selecting my own clinical site.

K. I have read the following Tuition information, Tuition refund,Cancellation, Tuition payment and interest policy, Student disclosures, Communications policy ,Withdrawal policy and Privacy Policy. *

Yes No

L. As a student I understand that I have received the guidelines, and detailed information regarding the institution regulations and information about my program. I have been explained my responsibilities as a student. I acknowledge the following and provide my initials next to the acknowledgement:

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, [school name] must provide me copies of transfer agreements that name the exact institution(s *

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

8. I understand that I have read all the terms and I am comfortable with abiding with the institution regulations. *

9. I understand that the institution has explained to me it's policies for admission, academic, tuition, and discussed with me my responsibilities as a student and that I am responsible for contacting them in any issue or problems. *

10. I understand that the school may terminate my enrollment if I fail to comply with attendance, academic, communication policy, and financial requirements or if I fail to abide by established standards of conduct, as outlined in the school handbook . While enrolled in the school, I understand that I must maintain satisfactory academic progress as described in the school handbook and that my financial obligation to the school must be paid in full before a certificate or credential may be awarded. *

Please Sign the document before submitting. The document requires your e-signature *

E-signature can be done by your keypad and confirms your agreement to our institution terms Clear

Notes:

Please indicate any questions you may have for the admissions team.

To be filled by Institution Office

Email given to student by the institution

SKOKIE INSTITUTE OF ALLIED HEALTH AND TECHNOLOGY(SIAHT) 2700 Patriot Blvd, Suite 250, Glenview IL 60026