ENTRANCE REQUIREMENTS:  Students must be able to read and write English at a 5th-grade level. Any prospective student must be at least 18 years of age, or will be 18 years of age at the time the program is completed as MAP policy requires that personnel be at least 18 years of age to be certified to administer medications. Students must have a clean CORI, Green Card, and/or citizenship for employment.

This course will run on a weekly basis based on student enrollment

 

TUESDAY/WEDNESDAY THURSDAY

8 am to 1 pm 8 am to 2 pm

Begins: ___/___/___ Ends: ___/___/___

 

 

medication administration program		Estimate of Additional Fees to be Incurred by Student:
Tuition	$545	Testing Fee w/ d&S diversified technologies: $96
Books	$ 30
Supplies	$
Total Charges	$575
Discounts, if any	$
Total	$

 

Student’s Method of Payment: 

___          Cash

___          Check or Money Order

 

The training is ONLY for individuals seeking employment with, or are currently working for, DDS and DMH.

-The training prepares students to take the MAP certification test (written and skills), which is offered only through D&S Diversified Technologies at an additional cost, and this certification is necessary for employment.

 

 

Refund Law (as per M.G.L. Chapter 255, Section 13K):	Dates:
1.   You may terminate this agreement at any time.	N/A
2.   If you terminate this agreement within five days you will receive a refund of all monies paid, provided that you have not commenced the program. Refund Amount: $1,500 (NA/HHA) $ 575.00(MAP)	5th day after the date both parties have signed the contract Date:
3.   If you subsequently terminate this agreement prior to the commencement of the program, you will receive a refund of all monies paid, less the actual reasonable administrative costs described in paragraph 7.  Refund Amount: ($1,500 – $  50.00 admin fee/ $1,450(NA/HHA) ($575-$50 admin fee/ $525.00(MAP)	Program start date Date:
4.   If you terminate this agreement during the first quarter of the program, you will receive a refund of at least seventy-five percent of the tuition, less the actual reasonable administrative costs described in paragraph 7. Refund Amount: $1125.00(NA/HHA) $408.75(MAP)	Last date of the first quarter Date:
5.   If you terminate this agreement during the second quarter of the program, you will receive a refund of at least fifty percent of the tuition, less the actual reasonable administrative costs described in paragraph 7. Refund Amount:  $750.00(NA/HHA) $272.50(MAP)	Last date of the second quarter Date:
6.   If you terminate this agreement during the third quarter of the program, you will receive a refund of at least twenty-five percent of the tuition, less the actual reasonable administrative costs described in paragraph 7. Refund Amount: $375.00(NA/HHA) $136.35(MAP)	Last date of the third quarter Date:
7.   If you terminate this agreement after the initial five-day period, you will be responsible for actual reasonable administrative costs incurred by the school to enroll you and to process your application, which administrative costs shall not exceed fifty dollars or five percent of the contract price, whichever is less.  A list of such administrative costs is attached hereto and made a part of this agreement.	5th day after the date both parties have signed the contract Date:
8.   If you wish to terminate this agreement, you must inform the school in writing of your termination, which will become effective on the day, such writing is mailed.	N/A
9.   The school is not obligated to provide any refund if you terminate this agreement during the fourth quarter of the program.	First day of the fourth quarter Date:

Administrative Costs Equal: $ 50.00

FINANCIAL AID: Per 230 CMR 15.04 (5) and (6)

(5) After April 1, 2017, if a school allows a student to begin participation in a Program while an initial award for financial aid, including student loans, is pending, and the student subsequently is denied some or all of that student loan or financial aid amount, the school shall offer that student in writing an opportunity to terminate the enrollment agreement with a full refund of all Monies Paid, less actual reasonable administrative costs as defined under M.G.L. c. 255, §13K.

(6) In addition to the requirements of M.G.L. c. 255, § 13K, for programs beginning after April 1, 2017, prior to the completion of five school days or five percent of the Program, whichever occurs first, a School shall afford a student the opportunity to withdraw with a full refund of all Monies Paid, less (1) actual reasonable administrative costs as defined under M.G.L. c. 255, § 13K; and (2) the actual reasonable cost of non-reusable supplies or Equipment where a school reasonably provided the student with the supplies or Equipment, so long as the student receives the refund to which they are entitled under M.G.L. c. 255, §13K. Provided, however, that this provision shall not apply to (1) Programs not subject to division approval; and (2) Programs 80 hours or less in duration and $2,000 in total cost.

 

I have been provided a copy of the school’s catalog and policies in a manner of my choosing and I am initialing my choice:  ___ hard copy   ___ USB Drive              ___ send via email

 

Student’s Initials

___ I understand this contract will not be in force and effect until signed by both myself and a school representative.

 

___ I have received a copy of the school’s complaint procedures policy.

 

___ I understand the refund law as stated above.

 

___ I understand that coursework and/or credit from this school may not be transferable to other institutions of education and acceptance is at the discretion of the receiving institution.

 

This school is licensed by the Massachusetts Division of Professional Licensure’s Office of Private Occupational School Education.  Any comments, questions, or concerns about this school’s license should be directed to occupational.schools@mass.gov or 617-701-8719.

 

Any changes, addendums, or additions made subsequent to the signing of the enrollment agreement must be in writing and signed by both the school and the student and are subject to the regulations of 230 CMR 15.04.

 

You have the right to cancel this enrollment contract before the completion of five school days or five percent of this Program, or course, whichever occurs first, and to receive a full refund of all monies paid, less actual reasonable administrative costs up to $50 and actual reasonable costs of non-reusable supplies or equipment.

Refund Amount: $1,500.00(NA)

                           $575.00(MAP)

 

You have the right to cancel this enrollment contract if a school allows you to begin participation in a Program while an initial award for financial aid, including student loans, is pending, and you are subsequently denied some or all of that student loan or financial aid amount, the school shall offer you, in writing, an opportunity to terminate this agreement.

 

Student’s Signature:  ________________________________________Date:__________________