Advanced Health Career Program Enrollment

In Case of Emergency
Name of local friend or relative (not living at same address)*
Relationship to student*
Home phone number*
Work phone number*

TrainerConnect

Columbus, IN 47201 | 812-373-6654 | www.trainerconnect.co

This institution is regulated by: The State of Indiana Department of Workforce Development, Office for Career and Technical Schools | 10 N Senate Avenue, Suite SE 308 Indianapolis, IN 46204 | OCTS@dwd.in.gov http://www.in.gov/dwd/2731.htm
Acknowledgements
- For a student to cancel a course they must submit a cancellation refund request to: TrainerConnect, 3129 25th Street #302, Columbus, IN 47203. Must be postmarked within 2 days prior to the class start. This contract is not subject to any change unless it is in written form and authorized by the student and school.
- See OCTS Full Refund Policy (only applies to Self Pay enrollees).
- Class schedules may change as deemed needed or based on enrollment and current hour requirements. Complaints must be submitted to the school to be resolved before submitting to the State of Indiana’s Office of Career and Technical Schools (OCTS). Then complaints against the school can be submitted to OCTS.
- In the event that TrainerConnect is required to take legal recourse against me for breach of contract, I understand that, in addition to the full cost of the instructional program, I’ll be responsible for all fees incurred by TrainerConnect in pursuing the unpaid balance or other breach.
- Tuition assistance reimbursement or self-pay must be paid in full prior to the class start. All books, fees and supplies are included in the tuition cost.
  I also agree that the class venue will be in Columbus, IN. TrainerConnect in collaboration with Cummins Inc. reserves the right to change class times or locations.
- Do not sign this agreement before you read it or if it contains any blank spaces.
  This is a legal instrument. All pages of the contract are binding. Read all pages before signing.
- You are entitled to an exact copy of the agreement and any disclosure pages you sign.
- This contract and the school catalog constitute the entire agreement between the student and the school.
- Under law you have the right among others, to pay the full amount due.
- The agreement is a legally binding instrument when signed by the student and accepted by the school.
- The terms and conditions of this agreement are not subject to amendment or modification by oral agreement.
- Any changes in this agreement 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.
- I certify that I have received a copy or viewed the web site of this school’s current catalog and that I agree to the catalog and the terms set forth in this agreement
- I certify that I have never received a degree from any accredited institution (in the United States or abroad)
- I certify that I have never participated in other Workforce Ready Grant programs in the State of Indiana.
Student Acknowledgments
- I have received a copy of the TrainerConnect policies and enrollment agreement.
- I have received a copy of the OCTS Refund Policy.
- 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. While enrolled in the school, I understand that I must maintain satisfactory academic progress before a certificate may be awarded.
- I hereby authorize TrainerConnect and/or its agents to make investigation of my background and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for this program.
- I hereby consent to the use, reproduction, editing and/or broadcasting by TrainerConnect of any and all photographs, video recordings and audio recordings of me taken by or on behalf of TrainerConnect, from this day on. All negatives and positives, prints, video-recorded images and audio recordings shall constitute the property of TrainerConnect.
Training Course Acknowledgement*

Release: I agree to release my name, address, dates of attendance and program status when requested by the government or any/all regulatory bodies. To withhold disclosure of this information, I must provide written notification separately to the Instructor. All changes of name, address or phone information during your program dates must be reported to the Instructor immediately.I hereby authorize TrainerConnect to contact me by automated SMS text message. I understand that message/data rates may apply to messages sent by TrainerConnect or its affiliates under my cell phone plan.
Student initials*
Signature of Student (Signature of Guardian if Student is Under 18 Years of Age)*

Clear
Date*

MonthDayYear
Date
Signature of school official
Should be Empty:

Dental Assisting

Class Schedule

Student Information

In Case of Emergency

Acknowledgements