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ENROLLMENT AGREEMENT

If you have any questions, you may contact us at 541-343-3100 during business hours or by email at admin@oregonmedicaltraining.com  Required Student Information - in accordance with OAR 715-045-0018

Birthday
Month
Day
Year

Your ss# is protected by extra layers of security

Select program(s) you are applying for
Gender
Male
Female
Other
Will you be 18 or older at the commencement of class
Yes
No
Race
Hispanic or Latino
Native American or Alaskan Native
Asian
Native Hawaiian or Pacific Islander
Caucasian
Other
Are you a U.S. citizen
Yes
No
Are you an Oregon resident
Yes
No
Are you a veteran
Yes
No
Are you disabled
Yes
No
What document did you obtain
High school diploma
GED
International high school diploma
I did not receive diploma or GED

Drivers license, state issued ID, Passport or any government issued ID

Diploma, GED, other college diploma or certificate received

How did you hear about us
Please select party making tuition payments
I am working with Worksource Lane, STEP or similar support agency
I am working with SEIU-UHW Joint Employer Education Fund
I will be responsible for making my own payment

Please note, you will not be considered enrolled until at least the registration and supply fees are paid after submitting this form. If you are working with a support agency, please close out payment page after submission.

Tuition and Fees
I understand if tuition is not paid by 50% of course completion it will result in academic suspension or termination
Yes
I understand I will need to purchase or rent my textbooks by the first day of class
Yes

Cancellation and Refund Policies (OAR 715-045-001)


A student may cancel enrollment by submitting a Student Request Application (SRA) to the school. The “date of enrollment” is the date at which the enrollment agreement was signed by both the student and authorized school official. Students who withdraw from the course are not entitled to any further resources provided by OMT. Unless the school has discontinued the program of instruction, the student is financially obligated to the school according to the following:


● If cancellation occurs within five business days of the date of enrollment, and before the commencement of classes, all monies specific to the enrollment agreement shall be refunded.


● If cancellation occurs after five business days of the date of enrollment, and before the commencement of classes, the school shall retain only the published registration fee. Such fee shall not exceed 15% of tuition cost, or $150, whichever is less.


● If withdrawal or termination occurs after the commencement of classes and before completion of 50% of the contracted instruction program, the student shall be charged according to the published class schedule. The student shall be entitled to a pro rata refund of the tuition when the amount paid exceeds the charges owed to the school. In addition to the prorated tuition, the school may retain the registration fee, supply fee, $25.00 withdrawal fee, and other legitimate charges owed by the student.


● Pro rata refund means a refund of tuition paid for that portion of the program not offered to the student prior to withdrawal. The date for determining that portion shall be the published course schedule and the last recorded date of attendance by the student.


If withdrawal or termination occurs after the completion of 50% or more of the program, the student shall be obligated for the tuition charged for the entire program and shall not be entitled to any refund.

Additionally, I understand the following:


After failure to attend class the first week, the school will attempt to contact the student via email and phone. It will then become the student's responsibility to provide written notice to the school to cancel enrollment. If a registered student attends a single class, but is absent from every day of class forward, and has failed to notify Oregon Medical Training, PCS of the intended withdrawal after completion of 50% or more of the program, the student will forfeit registration, supply fee (if given supplies) and 50% tuition.


The tuition charges will accrue based on hours that the program is offered by the school and that I have contracted/scheduled to attend, rather than my actual attendance


That any refund calculation is based on my last date of physical attendance.


Per OAR 715-0045-0008, Advanced Deposits, "Prior to the beginning of classes, no private career school shall require from an enrollee an advance deposit in excess of twenty (20) percent of the total tuition and fees


Schools that offer short-term programs designed to be completed in 1 term or 4 months, whichever is less, can require payment of all tuition and fees on the first day instruction begins


For those programs designed to be 4 months or longer, a school cannot require more than one term or 4 months of advanced payment of tuition at a time. When 50% of the program has been offered, the school can require payment of all tuition


This limitation shall not apply to federal and state financial aid payments received by the school


At the student's option, a school may accept payment in full for tuition and fees after the student has been accepted and enrolled and the date for commencement of classes is specifically disclosed on the enrollment agreement





Any inquiry a student may have regarding this contract may be made in writing to:


Oregon Medical Training, PCS, 1126 Gateway Loop, Suite 108, Springfield, OR 97477


Or to the Superintendent of Public Instruction, Oregon Higher Education Coordinating Commission:


255 Capitol St. NE, Salem, OR 97310


or by calling (503) 947-5751


My signature indicates I have read and understand the refund policy above, enrollment agreement, school catalog, have copies of each and agree to stipulations listed in them. I further understand this is a binding contract.

Date
Month
Day
Year
ADMINISTRATOR ONLY
Month
Day
Year
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