3 DIMENSIONS HEALTH SERVICES

Dracut Campus
1934 Lakeview Ave
(Beaver Brook Village)
Dracut, MA , 01826

Phone: 978-735-4451
Fax : 978-735-4458
Email: Info@3dimensionshealth.com
Worcester Campus
61 Harvard St
Worcester, MA. 01609
Phone: 508-799-9786
Fax: 508-799-9728
Application/Enrollment Agreement Form
COURSE NAME:  NURSING ASSISTANT : 100 CLOCK HRS REQUIRED
STUDENT NAME:
PHONE:
EMAIl ID:
ADDRESS:
DATE OF APPLICATION:
DATE COURSE BEGINS
DATE COURSE ENDS:
CLOCK HOURS:
COMMENTS:

Fees
Tuition :                            
Books & Badges :          
Administration Fee :     
Total:                                $920.00 only

 

 
Essential Functions/Requirements:  

The following is a list of essential functions and requirements of each potential student. Students must be able to perform these functions in order to be successful. Students not able to perform these duties may not be granted acceptance into nursing assistant program.

Ability to lift, bend and squat
Ability to move or lift up to 50 pounds without any restrictions
Must be able to communicate in English. This includes reading, writing and speaking as all textbooks patient charts and medical records are all printed in English

   
 
Refund Policy (as per M.G.L. Chapter 255, Section 13K)
  1. You may terminate this agreement at any time.
  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.
  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. 
  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.
  5. If you terminate this agreement during the second quarter of the program, you will receive a refund of at least fifty per cent of the tuition, less the actual reasonable administrative costs described in paragraph 7.
  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.
  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.
  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.
  9. The school is not obligated to provide any refund if you terminate this agreement during the fourth quarter of the program.
Administrative Costs Equal:  $ 25.00    

A completed and signed copy of this agreement must be provided to the student. This school is licensed by the Division of Professional Licensure, Office of Private Occupational School Education. Any comments, questions, or concerns about this school’s license should be directed to Division of Professional Licensure, Or 617-727-5811

Student Signature: Date
School Official Signature: Date