registration form
The Training Center
4595 Walnut Rd –Unit M
PO Box 116, Buckeye Lake Oh 43008
Office 740-994-4301, Fax 740-205-0097
www.thetrainingcenter.info



Student: ________________________________________________ Birth Date: _________________

Address: __________________________________________________________________________

Phone Number: ____________________________Alternate Phone: ___________________________

S.S. Number: _________________________ E-mail Address_________________________________

I am hereby enrolling in the following academic program and my enrollment is subject to the terms and
conditions stated in this enrollment agreement.

Program Name
(check all that apply): STNA  _________   Phlebotomy  ________  EKG ________
      
Start Date: ______
___________________    Graduation date: ________________________    

Final class percentage (To be filled out by instructor): __________________________________

Expected program length: STNA- 75 Clock Hrs. Phlebotomy- 80 Clock Hrs   EKG- 50 Clock Hrs

This program is normally completed within 3 calendar weeks (12 DAYS)

                                                           
 Tuition and Fees:

STNA                                                         Phlebotomy                                        EKG

Registration Fee… $75.00              Registration Fee... $120.00          Registration Fee...$100.00
Tuition………….... $480.00             Tuition…................$680.00          Tuition...............…$560.00
Maintenance fee…$70.00               Maintenance Fee...$70.00            Maintenance fees..$70.00
Total Cost….……. $625.00             Total Cost........…...$870.00          Total Cost………...$730.00


Tuition and fee charges are subject to change at the school’s discretion. Any tuition or fee increases will
become effective for the school term following student notification of the increase.

Cancellation and Settlement Policy        
This enrollment agreement may be cancelled within five calendar days after the date of signing provided
that the school is notified of the cancellation in writing. If such cancellation is made, the school will refund
in full all tuition and fees paid pursuant to the enrollment agreement and the refund shall be made no
later than thirty days after cancellation. This provision shall not apply if the student has already started
academic classes.

Refund Policy        
If the student is not accepted into the training program, all monies paid by the student shall be refunded.
There is one (1) academic term for this program. Refunds for tuition and refundable fees shall be made in
accordance with following provisions as established by Ohio Administrative Code section 3332-1-10:

(1)        A student who withdraws before the first class and after the 5-day cancellation period shall be
obligated for the registration fee.

(2)        A student who starts class and withdraws before the academic term is 15% completed (12 clock
hours) will be obligated for 25% of the tuition and refundable fees plus the registration fee.

(3)        A student who starts class and withdraws after the academic term is 15% complete but before the
academic term is 25% completed (20 clock hours) will be obligated for 50% of the tuition and refundable
fees plus the registration fee.

(4)        A student who starts class and withdraws after the academic term is 25% complete but before the
academic term is 40% completed (32 clock hours) will be obligated for 75% of the tuition and refundable
fees plus the registration fee.

(5)        A student who starts class and withdraws after the academic term is 40% completed will not be
entitled to a refund of the tuition and fees.

The school shall make the appropriate refund within thirty days of the date the school is able to determine
that a student has withdrawn or has been terminated from a program. Refunds shall be based upon the
last date of a student’s attendance or participation in an academic school activity.

Complaint or Grievance Procedure        
All student complaints should be first directed to the school personnel involved. If no resolution is
forthcoming, a written complaint shall be submitted to the director of the school. Whether or not the
problem or complaint has been resolved to his/her satisfaction by the school, the student may direct any
problem or complaint to the Executive Director, State Board of Career Colleges and Schools, 30 East
Broad Street, Suite 2481, Columbus, Ohio 43215, Phone 614-466-2752; toll free 877-275-4219.

I acknowledge that I have received a school catalog and agree with the school policies and procedures as
stated. I acknowledge that I have received and read a copy of this enrollment agreement.  

Applicant signature: _____________________________________date: __________________  

Parent or Guardian (if applicable): __________________________date: __________________

School representative:
 Debra Ziadeh RN

Requirements for STNA Class

1. Complete Enrollment Agreement & Tuition arrangements
2. Must be 16 years or older
3. Must have 2 step TB test completed prior to Clinicals
4.
Complete the Ohio student disclosure course

Requirements for Phlebotomy class

1. Must Have High School Diploma or GED
2. Must be a minimum of 16 yrs old.
3. Complete Enrollment Agreement & Tuition arrangements

Requirements for EKG class

1. Must be at least 16 yrs. old
2. Have a high school diploma or GED,
3. Have a Phlebotomy Certification.
4. Complete Enrollment Agreement & Tuition arrangements   

                                    
                                               Graduation Requirements:

Complete all requested hours of class, skills and labs
Pass total of all tests/exams with 75% for STNA and 70% for Phlebotomy and EKG or better
Tuition paid in full


Education Level:  Less than high school __
____   High School Graduate ______   GED ______   
associate degree _____   Bachelor’s Degree _____   Master’s Degree _____   Master’s Plus_____

How did you hear about The Training Center?  Employment Guide/Newspaper __
___ Job Fair____
Facebook_____ Business cards/Flyers __
___ Opportunity Links _____ Web site _____
Job & Family Services __________ Other__________________________________________

Check those that apply:     ______SELF PAY
(PAID IN FULL)     ______PAYMENT PLAN
(I understand that NO REFUNDS will be given with this plan) INITIAL ________

                            COMPANY/AGENCY/SPONSOR (*please attach documentation) __________

                                                           Company/Agency/Sponsor
Name__________________________________________Authorized By________________________

Phone___________________ Address____________________________________ PO Box#_______

City_______________________________________State__________________Zip Code__________

                           ******Cannot sit for State Exam if any monies are owed*******

(*Registration is incomplete without Company/Agency/Sponsor support documentation/ letterhead*)
(Please make checks/money orders payable to The Training Center)

I, the undersigned, understand that my enrollment is voluntary and that I shall not hold the school or its
officials responsible for injury resulting from my action or conduct. In the event of an accident, I give my
permission for the instructor or school
official to contact the ambulance service and facilitate medical attention of my injuries in the necessary
manner.

Signature_____________________________________________Date___________________

Person to notify in case of emergency________________________________ Relationship__________

Phone_______________________________ Alternate Phone______________________________

***I have recognized the placement statistics at the time of registration at The Training Center***

    Applicant Signature______________________________                  Date________________