7-13 Sandy Hernandez-Signed PDF

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.
edu
Main Campus: 4670 Auto Mall Parkway, Fremont, CA 94538
Branch Campus:1901 Charcot Ave, San Jose, CA 95131
Branch Campus: 1111 Howe Ave, Suite 300, Sacramento CA 95825
VOCATIONAL NURSING PREREQUISITES PROGRAM ENROLLMENT AGREEMENT

DOB: 05/04/1974
DATE:
April 14, 2015
STUDENT NUMBER: 209989
STUDENT NAME (LAST, FIRST): Hernandez, Sandy

STREET ADDRESS: 1120 sherman st
CITY: San Jose
STATE: CA
HOME TELEPHONE #: 408-781-8420
MOBILE TELEPHONE#:
ZIP: 95110
EMA IL: sandyhernandez74@gmail.com

PROGRAM SCHEDULE
PROGRAM DURATION
Program Title:
Vocational Nurse Pre-Reqs
Program Type:
Prerequisites
Training Location:
Pre-Req Duration Hours: 80
TUITION & FEES

Registration Fee:
150.00*
Text Books:
197.00**
Fremont
Equipment/Kit/Uniforms:
0.00
Pre-Req Start Date:
07/13/2015
Misc Fees:
52.50*
Pre-Req End Date:
7/29/2015
Student Tuition Recovery Fund:
0.00*
1 week Tuesday Friday

2nd week Monday Friday
3rd week Monday Friday
4th week Monday Tuesday
Training Costs:
$ 2,750.50
Days: 16
st
Class Days and Time:
TOTAL TUITION FOR ENTIRE PROGRAM: $ 3,150.00

TOTAL CHARGES FOR CURRENT PERIOD OF ATTENDANCE: $ 3,150.00
5:30 pm 10:30 pm
* = NON REFUNDABLE
** = NON REFUNDABLE IF USED
Admissions Representative: Nick Marsh
STUDENT IS RESPONSIBLE FOR TOTAL TUITION INDICATED ABOVE. IF STUDENT RECEIVES A LOAN, STUDENT IS RESPONSIBLE FOR REPAYING THE
LOAN AMOUNT PLUS ANY INTEREST, LESS THE AMOUNT OF ANY REFUND. [
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Student Signature:
If I fail to repa a federal or state go er e t loa or a loa guara tee age
loa ,
i o e ta refu d ould e take away, and I would
not be able to get other student financial aid or government housing assistance until I pay off the loan. I am responsible for this amount and if I
cancel my loan without notification, I may be subject to relinquishing my seat. If I get a student loan, I understand I am responsible for repaying
the loa plus i terest .
"Prior to signing this enrollment agreement, you must be given a catalog or brochure and a School Performance Fact Sheet, which you are
encouraged to review prior to signing this agreement. These documents contain important policies and performance data for this institution.
This institution is required to have you sign and date the information included in the School Performance Fact Sheet relating to completion
rates, placement rates, license examination passage rates, salaries or ages, a d the ost re e t three ear ohort default rate, if appli a le,
prior to signing this agreement."
Initials: [sh
i:a:r ] "I certify that I have received the catalog, School Performance Fact Sheet, and information regarding completion rates,
placement rates, license examination passage rates, salary or wage information, and the most recent three-year cohort default rate, if
applicable, included in the School Performance Fact sheet, and have signed, initialed, and dated the information provided in the School
Performance Fact Sheet." Any questions a student may have regarding this enrollment agreement that have not been satisfactorily answered by
the Unitek College may be directed to the Bureau for Private Postsecondary Education at 2535 Capitol Oaks Drive Suite 400, Sacramento, CA 95833,
www.bppe.ca.gov or toll free at (888) 370-7589 or by fax (916) 263-1897. A student or any member of the public may file a complaint about this
Unitek College with the Bureau for Private Postsecondary Education by calling (888) 370-7589 or by completing a complaint form, which can be
o tai ed o the u eau s I te et We site www.bppe.ca.gov.
All documents referred to in this agreement become an integral part of the complete agreement.
I understand that this is a legally binding contract when signed by the student and accepted by the institution.
I u dersta d that this is a legall i di g o tra t. M sig ature elo ertifies that I ha e read, u derstood, a d agreed to my rights and
respo si ilities, a d that the U itek Colleges a ellatio a d refu d poli ies ha e ee learl e plai ed to e.
[
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SIGNATURE OF STUDENT
[04/15/2015
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]
DATE
SIGNATURE OF PARENT/GUARDIAN
DATE
APPROVED BY SCHOOL OFFICIAL:___________________________________________________________ DATE:_______________________ ___

Copyright Unitek College
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UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

GENERAL TERMS
1.
All references to Applicant or Student indicate the individual named on the first page of this Program Enrollment Agreement. The reference to
tude t a also appl to tude t s Co-Signer or Parent or Guardian, if applicable, on this Program Enrollment Agreement. This Program
Enrollment Agreement may be referred to as Agreement throughout this contract. Unitek College may be referred to as Unitek College or
School. For this Program Enrollment Agreement, the Program of study indicated on the first page may be referred to as Program or Course.
2.
No applicant shall be discriminated against or rejected from admission to Unitek College on the basis of age, race, color, sex, sexual
orientation, disability or national origin. For information regarding Non-Discrimination or to resolve complaints contact the Campus Director.
For the establishment of proper student records, Student gives Unitek College administrative employees permission to view Stude t s e o ds.
3.
Unitek College cannot promise employment or level of income to any student or graduate. Student understands that employer reserve the
right to run background check based on their company policies.
4.
Student understands that Unitek College is a private post-se o da s hool. U itek College s pa e t o pa , Unitek Information Systems,
owns another training institute called Unitek Education. Unitek Education and its programs are in no way affiliated with Unitek College.
tude t a e o ta ted the U itek College ai a pus i F e o t ega di g tude t s education or employment. Student may also be
o ta ted U itek College s pa e t o pa , U itek I fo atio ste s, ega di g tude t s fi a ial a ou t status. Both offices are
located at 4670 Auto Mall Parkway, Fremont, CA 94538. Unitek Information Systems may be reached at 510-249-1060.
5.
Once the student has paid all tuition per the tuition payment schedule, books and supplies for the program will be provided by Unitek College
unless Student elects to opt out (see the All-Inclusive Tuition Opt-Out Form included in this Agreement). If the student withdraws, Unitek
College reserves the right to accept or deny returned items based on the condition of the item. Any Lost, damaged or stolen items must be
epla ed at tude t s e pe se.
6.
Official Transcript, Completion Certificate or Degree, may be issued only after the entire program has been successfully completed and all fees
are paid in full or otherwise accounted for.
7.
Clinical Rotation or Externship assignments (if applicable) are the result of collaborative efforts and educational partnership contracts between
external organizations/facilities and Unitek College. The particular organization or facility assigned to Student is subject to change on short
notice, and Clinical Rotations or Externships with any specific organization or facility are not guaranteed in advance. All facilities used for
Vocational Nursing and Registered Nursing Clinical Rotations must be approved by BVNPT and BRN respectively, All Externship
organizations/facilities must be approved by the Director of career services.
8.
The start and completion dates of Programs are subject to change, and Unitek College reserves the right to postpone the start of a Program.
In such cases Student will be duly notified and offered the opportunity to consent to the new Program dates. The maximum postponement of
a Program start date is 90 days, beyond which a full refund of all monies paid will be offered.
9.
In the event that Unitek College discontinues a program, a full refund of all monies paid will be given to students who have enrolled but not
started in the discontinued program.
10. Unitek College reserves the right to change or modify, without notification to Student, the Program content, equipment, staff, materials or
organization. In no event will such changes diminish the quality of the program or result in tuition changes for currently-enrolled students.
11. U itek College ese es the ight to eje t a Appli a t ho does ot eet the P og a ad issio e ui e e ts. tude t s e rollment may
be ter i ated at the ele tio of the Chief A ade i Offi e , Ca pus Di e to , o P og a Di e to if tude t s a ade i p og ess, ehavior,
a se es, o ta di ess does ot o fo to U itek College s poli ies as stated i the hool Catalog. I su h e e t, the e te t of tude t s
tuitio o ligatio ill e i a o da e ith U itek College s efu d poli , as efe e ed i this ag ee e t.
12. If this Agreement is assigned to a third party, Student will continue to be bound by all the terms and conditions of this Agreement. If this
Agreement is so assigned, any dispute regarding this Agreement must be settled between Student and Unitek College.
13. Student is responsible for payment of any portion of the Total Tuition not covered by a third party. Student is ultimately responsible for
payment of Total Tuition. If any third party defaults or refuses to make payment, Student must immediately pay Unitek College the portion of
Total Tuition due and any additional fees, if incurred. Student must sign and adhere to a separate Retail Agreement for the fulfillment of
tuitio o ligatio s. etail Ag ee e ts a a
P og a a d stude ts eligi ilit fo Fede al tude t Aid, P i ate Loa s and other payment
options. The terms of the Retail Agreement are in addition to the terms of this Enrollment Agreement; should there be a conflict between the
terms of the two agreements, the Retail Agreement shall prevail.
14. If any section of this Agreement shall be deemed invalid or unenforceable, it shall not affect the other sections hereof, and this Agreement
shall be construed in all respects as if such invalid or unenforceable section was omitted.
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15. This Agreement constitutes the complete and fully integrated contract between Unitek College and Student, and supersedes all previous oral
and written agreements and discussions. This Agreement may be changed only by an agreement in writing between Unitek College and
Student. Student has read and understood this Agreement and has not entered into this Agreement in reliance on any promises made by
Unitek College or any of its representatives or agents.
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16. NOTICE CONCERNING TRANSFERABILITY OF CREDITS AND CREDENTIALS EARNED AT UNITEK COLLEGE: The transferability of credits earned
by Student at Unitek College is at the complete discretion of the institution to which Student may seek transfer to. Acceptance of the
certificate or degree Student earns at Unitek College is also at the complete discretion of the institution to which Student may seek to
transfer. If the credits, certificate or degree that Student earns at Unitek College are not accepted at the institution to which Student may seek
to transfer, Student may be required to repeat some or all of tude t s ou se o k at that i stitutio . Fo this easo tude t should ake
e tai that the edits, e tifi ate o deg ee asso iated ith tude t s hose P og a at U itek College ill eet tude t s educational
goals. This may include contacting an institution to which Student may seek to transfer after attending Unitek College to determine if
tude t s edits ill t a sfe .
17. Student understands that California State Law requires Unitek College to document the employment status of graduates, and therefore agrees
to assist U itek College i o tai i g a do u e tatio o i fo atio e uested U itek College to e if tude t s e plo ment status
after graduation for up to 2 years after graduation from Unitek College.
18. Student understands that if tude t s hose P og a
ith U itek College that e ui es a li e se i o de to o k i the field, the su h
li e si g odies e.g. Califo ia s Boa d of Vo atio al Nu si g a d Ps hiat i Te h i ia s, Boa d of Nu si g, Pha a Te h ician Certification
Board) may require a satisfactory background check in order to apply for or obtain the relevant license. Student understands that a criminal
record may prevent student from getting a license.
19. NOTICE: STUDENT MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE STUDENT SIGNED IN ORDER TO FINANCE THE COST OF THE
EDUCATIONAL PROGRAM ALL OF THE CLAIMS AND DEFENSES THAT STUDENT COULD ASSERT AGAINST THIS UNITEK COLLEGE, UP TO THE
AMOUNT STUDENT HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.
20. Student Tuition Recovery Fund
a.
b.
You must pay the state-imposed assessment for the Student Tuition Recovery Fund (STRF) if all of the following applies to you:
i.
You are a student, who is a California resident and prepays all or part of your tuition either by cash, guaranteed
student loans, or personal loans, and
ii.
Your total charges are not paid by any third-party payer such as an employer, government program or other payer
unless you have a separate agreement to repay the third party.
You are not eligible for protection from the STRF and you are not required to pay the STRF assessment, if either of the following
applies:
i.
You are not a California resident.
ii.
Your total charges are paid by a third party, such as an employer, government program or other payer, and you have
no separate agreement to repay the third party.
The state of Califo ia eated the tude t Tuitio e o e Fu d TF to elie e o itigate e o o i losses suffe ed students in
education programs who are California residents, or are enrolled in a residency programs attending certain schools regulated by the
Bureau of Private Postsecondary Education.
You may be eligible for STRF if you are a California resident or are enrolled in a residency program, prepaid tuition, paid the STRF
assessment, and suffered an economic loss as a result of the following:
1.
The school closed before the course of the instruction was completed.
2.
The s hool s failu e to pa efu ds o ha ges o ehalf of a stude t to a thi d pa t fo li e se fees o a othe pu pose, or to
provide equipment or materials for which a charge was collected within 180 days before the closure of the school.
3.
The s hool s failu e to pa o ei u se loa p o eeds u de a fede all gua a teed stude t loa p og a
to pay or reimburse proceeds received by the school prior to closure in excess of tuition and other costs.
4.
There was a material failure to comply with the Act of this Division within 30 days before the school closed or, if the material
failure began earlier than 30 days prior to closure, the period determined by the Bureau.
5.
An inability after diligent efforts to prosecute, prove, and collect on a judgment against the institution for a violation of the A t.
as e ui ed
la or
However, no claim can be paid to any student without a social security number or a taxpayer identification number.
Note: Authority cited: Sections 94803, 94877 and 94923, Education Code. Reference: Section 94923, Education Code
21. State of California Approval Unitek College's application for approval to operate has ee e ie ed
Secondary Education (BPPE) resulting in a full approval which is set to expire on March 18, 2015.
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22. Unitek College purchases books from various vendors, often at volume discounts, and includes them by default within the total fees paid by a
stude t. This ethod is alled i lusi e tuitio a d edu es the u de o stude ts to fi d a d pu hase all e ui ed ooks themselves.
Student may opt out of paying inclusive tuition by signing the books waiver form, which will obligate student to acquire all necessary books by
the scheduled first day of class. By opting out of inclusive tuition and agreeing to purchase the required books, the total fees charged to the
student by Unitek College at the time of enrollment will be reduced by the then-current total costs paid by Unitek College to acquire the
books.
23. ASSIGNMENT OF INTEREST: (To be signed only if agreement is assigned) for valuable consideration, (the receipt and adequacy of which is
hereby acknowledged) Unitek College assigns all of its rights, title and interest in this agreement to: __________________________________
under the terms of the agreement between Unitek College and the assignee.
School official signature: _________________________________ Date: _________
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24. tude ts e olli g i U itek College s Vo atio al Nu si g VN p og a
a e ei e a o e-time $2,000.00 Alumni credit if they later meet the
ad issio s e ui e e ts a d e oll i U itek College s Asso iate Deg ee of Nu si g (ADN) program. This Alumni credit expires eighteen
months after the completion of the VN program. This is a promotional discount offer which cannot be combined with any other discounts and
is only applicable if all aspects of the Vocational Nursing training was taken at Unitek College. Unitek College reserves the right to discontinue
this promotional discount offer.
25. tude ts ho a e e olli g i U itek College s MA p og a a a ail of a o e-time $2,500.00 Alumni credit if they later meet the admissions
re ui e e t a d e oll i the U itek College s VN p og a , p o ided the VN p og a is ei g offe ed. This Alu i edit e pi es one year
after completion of the MA program and may be used with one enrollment only. The promotional discount offer cannot be combined with
any other discounts and is only applicable if all aspects of the MA training had been completed at the college. Unitek College reserves the right
to discontinue this promotional discount offer.
26. DISTANCE EDUCATION COURSES* (Applicable only for Distance Education Programs)
a.
School shall transmit the any necessary logins and materials to the student between four and seven days after the school
accepts the student for admission.
b.
Request of transmittal of materials: (1) School shall transmit all lessons and materials to student if student has fully paid for
program and, after receiving the first lesson and initial materials, requests in writing that all materials be sent; (2) if school
sends balance of materials at students request, school is obligated to provide the other educational services but shall not be
obligated to pay any refund after all lessons/materials are sent.
c.
The student will have the right to cancel the agreement and receive a full refund before the first lesson and materials are
received. If the school sent the first lesson and materials before an effective cancellation notice was received, the school shall
make a refund within 45 days after the student's return of the materials unless the student has begun the on-ground portion of
the program.
*Not all programs offer distance education courses

27. By signing this agreement I agree that Unitek College, its affiliates and agents, may send text messages to me. I will not hold Unitek College, its
affiliates or agents liable for any phone charges incurred through calls or the sending / receiving of text messages. I also understand that a
text message may not necessarily be sent for every important event or activity, and may be sent for information on job opportunities,
placement status, or information updates.
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My signature below certifies that I am an authorized representative of Unitek College and that I have personally explained Unitek Colleges
Cancellation & Refund Policies to the student.
Admission Representative (Print Name): Nick Marsh
Admission Representative (Signature):
________________
__________
Date:
Approved by School Official (Signature):
Date:
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE ABOVE TERMS FOR UNITEK COLLEGE.
[
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Student Signature:
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STUDENTS RIGHT TO CANCEL

1.
2.
3.
4.
5.
6.
7.
All monies paid by an applicant must be refunded if requested within three days after signing an enrollment agreement and making an
initial payment.
You have the right to cancel your enrollment for a program of instruction, without any penalty or obligations, through attendance at the
first class session or the seventh calendar day after enrollment, whichever is later. After the end of the cancellation period, you also have
the right to stop school at any time; and you have the right to receive a pro rata refund if you have completed 60 percent or less of the
scheduled days in the current payment period in your program through the last day of attendance.
Cancellation may occur when the student provides a notice of cancellation at the following address: 4670 Auto Mall Parkway, Fremont, CA
94538. This can be done by mail or by hand delivery.
The notice of cancellation, if sent by mail, is effective when deposited in the mail properly addressed with proper postage.
The notice of cancellation need not take any particular form and, however expressed, it is effective if it shows that the student no longer
wishes to be bound by the Enrollment Agreement.
If the Enrollment Agreement is cancelled the school will refund the student any money he/she paid, less a registration or administration
fee not to exceed $150.00, and less any deduction for equipment not returned in good condition, within 45 days after the notice of
cancellation is received.
]
You must exercise your right to cancel by the following date: [9/1/2015 t:a:r
TUDENT RIGHT TO REFUND

8. If student is receiving financial aid funds, student is entitled to a refund of moneys not paid from financial aid.
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WITHDRAWAL FROM THE PROGRAM

You may withdraw from the school at any time after the cancellation period (described above) and receive a pro rata refund if you have completed
60 percent or less of the scheduled days in the current payment period in your program through the last day of attendance. The refund will be less
a registration or administration fee not to exceed $150.00, and less any deduction for equipment not returned in good condition, within 45 days of
cancellation or withdrawal from program. If the student has completed more than 60% of the period of attendance for which the student was
charged, the tuition is considered earned and the student will receive no refund.
Students can drop classes by contacting the Registrar. Students who drop when enrolled from 0% to 75% of the calendar days of the applicable
se este , odule o sessio ill e ei e a W o thei t a s ipt. tude ts ho d op he e olled past this poi t ill e eive a letter grade on
their transcript.
For the purpose of determining date of determination for a refund under this section, a student shall be deemed to have cancelled from a program
of instruction when any of the following occurs:
The stude t otifies the i stitutio of the stude t s a ellatio o as of the date of the stude t s ithd a al, hi he e is later.
The institution te i ates the stude t s e oll e t fo failu e to ai tai satisfa to p og ess; failu e to a ide the ules a d
regulations of the institution; absences in excess of maximum set forth by the institution; and/or failure to meet financial obligations to
the School.
The student has failed to attend class for fourteen consecutive scheduled class or clinical days.
Failure to return from a leave of absence.
For determining the amount of the refund, the last date of recorded attendance will be utilized. The amount owed equals the daily charge for the
program (total institutional charge, minus non-refundable fees, divided by the number of days in the program), multiplied by the number of days
attended prior to withdrawal. For the purpose of determining when the refund must be paid, the refund will be issued 45 days from the date of
dete i atio . Fo p og a s e o d the u e t pa e t pe iod, if ou ithd a p io to the e t pa e t pe iod, all ha ges collected for the
next period will be refunded.
If the student has received any Federal Title IV financial aid funds, the school is obligated to do an R2T4 even if a credit balance has already been
issued. At the time of enrollment the student must indicate via the Authorization of Credit Balances form what authorization a student is giving
Unitek College as it relates to any excess funds. The choices include the following:
Authorizing Unitek College to retain and apply any credit balance to future charges and send student any credit balance resulting from
excessive funding after tuition has been fully paid.
Autho izi g U itek College to etu all edit ala e e ai i g o stude ts a ou t to le de a d ot autho izi g U itek College to
apply any credit balance to future charges. Furthermore, understanding that this option will make student responsible for any debt to
Unitek College.
Authorizing Unitek College to send student all credit balance remaining on their account. Furthermore, understanding that this option
will make student responsible for any debt to Unitek College.
It is the s hools espo si ilit to do a T a d the s hool is o ligated to do a T even if a credit balance was already issued and the school
eeds to get a u paid ala e f o stude t. Fo p og a s e o d the u e t pa e t pe iod, if ou ithd a p io to the e t pa e t
period, all charges collected for the next period will be refunded.
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AGREEMENT TO BINDING ARBITRATION AND WAIVER OF JURY TRIAL

I, Sandy Hernandez, agree that any dispute arising from my enrollment at Unitek College, no matter how described, pleaded or styled, shall be
resolved by binding arbitration under the substantive and procedural requirements of the Federal Arbitration Act, by a single arbitrator, conducted
by the Better Business Bureau BBB at thei Oakla d Califo ia Offi e, u de its ules. All dete i atio s as to the s ope, e fo ea ilit a d
effect of this arbitration agreement shall be decided by the arbitrator, and not by a court. The award rendered by the arbitrator may be entered in
any court having jurisdiction.
TERMS OF ARBITRATION
1.
Both Student and Unitek College irrevocably agree that any dispute between them shall be submitted to Arbitration.
2.
Neither the Student nor the College shall file or maintain any lawsuit in any court against the other, and agree that any suit filed in
violation of this Agreement shall be dismissed by the court in favor of an arbitration conducted pursuant to this Agreement.
3.
The a it ato s de isio shall e set fo th i

based.
4.
Any remedy available from a court under the law shall be available in the arbitration.
iti g a d shall set fo th the esse tial fi di gs a d o lusio s upo
hi h the decision is
PROCEDURE FOR FILING ARBITRATION

Students are strongly encouraged, but not required, to utilize the Grievance Procedure described in the Catalog, prior to filing arbitration.
A student desiring to file arbitration should first contact the Campus Director, who will provide the student with a copy of the BBB Rules. A Student
desiring to file Arbitration should then contact the Better Business Bureau at Oakland California Office, which will provide the appropriate forms
and detailed instructions. The Student should bring this form to BBB.
A student may, but need not, be represented by an attorney at the Arbitration.
Acknowledgement of Waiver of Jury Trial and Availability of BBB Rules
By my signature below, I acknowledge that I understand that both the College and I are irrevocably waiving rights to a trial by jury, and are selecting
instead to submit any and all claims to the decision of an arbitrator instead of a court. I understand that the award of the arbitrator will be binding,
and not merely advisory.
I also acknowledge that I may at any time, before or after my admission, obtain a copy of the Rules of the Better Business Bureau, at no cost, from
the BBB.
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Student Signature:
Date:
[04/15/2015
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School Official Signature: ________________________________________________ Date:____________ ____________
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ALL-INCLUSIVE TUITION OPT OUT WAIVER
X I DO NOT wish to opt out of books and supplies.

[c:a:r]
Sandy Hernandez
Student Name
Student Signature
s:a:r
[04/15/2015
d:a:r
]
Date
If electing to opt out:

I, Sandy Hernandez, have decided that I am opting out of the allinclusive tuition and wish to make my own arrangements for all required items for
the Licensed Vocational Nursing program.
I acknowledge that is it my responsibility to have the books and/or supplies needed to successfully participate in any class lecture or lab work.
Furthermore, I understand that by opting out of this all inclusive tuition, I am fully responsible in acquiring all the necessary books and supplies
needed to successfully complete the program, as indicated on the attached pages.
SELECT ONE:
I wish to opt out of the books and supplies.

I wish to opt out of the books only.
I wish to opt out of the supplies only.
Sandy Hernandez
Student Name
Student Signature
Date
Purchasing Books & Supplies POLICY:

Unitek College purchases Books & Supplies from various vendors, often at volume discounts, and includes them by default
within the total fees paid by a student. This method is called inclusive tuition and reduces the burden on students to find
and purchase all required Books & Supplies themselves. Student may opt out of paying the inclusive tuition, which will
obligate student to acquire all necessary books & supplies by the scheduled first day of class. By opting out of inclusive
tuition and agreeing to purchase the required books & supplies yourself, the total fees charged to student by Unitek College
at the time of enrollment will be reduced by the then-current total costs paid by Unitek to acquire the books and supplies.
Once a student has opted out of books or supplies they cannot opt back in but instead will need to purchase the books
and/or supplies from Student Services.
Received By:
School Official
Date
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Student Performance Fact Sheet - 2012 & 2013

Program Vocational Nursing
Program Length 11 Months
Campus: Fremont (Main), San Jose (Branch), Sacramento (Branch)
Completion Rates
Completed in 100%
Calendar Year
Number of Students Who Began Program
2012
2013
Students Available for

2
Graduation
166
342
166
342
Graduates
Completion Rate
126
126
50%
37%
Completed in 101% to 150%

Calendar Year
Number of Students Who Began

1
Program
Students Available for

2
Graduation
150%
5
Graduates
150% Completion
6
Rate
73
342
73
342
60
120
25%
39%
2012
2013
Calendar
Year
Number of
Students
Who Began
1
Program
Number of
3
Graduates
Graduates
available for
7
Employment
Graduates
Employed in
8
the Field
Placement Rate
Employed in
9
the Field
Graduates Employed
in the Field less than
32 hrs/wk
2012
166
126
103
22
21%
Graduates
Employed in
the Field at
least 32 hrs/wk
19
2013
342
126
100
21
21%
17
Placement Rates
Students are entitled to a list of the job classifications considered to be in the field of this educational program. To obtain this list, please ask an institutional
ep ese tati e o ou a e ie the list of the i stitutio s e site at http://www.schoolofchoice.com/jobclassifications.
License Examination Passage Rates (continually administered tests)

The rates are based on students completing the program and taking the NCLEX-PN exam in the year indicated.
10
13
12
Calendar Year
# Taking Exam
# Who Passed First Exam
# Who Failed First Exam
Passage Rates
2012 - Fremont
2012 - San Jose
2012 - Sacramento
2013 - Fremont
2013 - San Jose
2013 -Sacramento
91
31
45
50
45
48
83
25
33
42
39
41
8
6
12
8
6
7
91.21
80.65
73.33
84.00
86.67
85.42
Salary and Wage Information

Calendar
Year
2012
2013
Grads Avail for

7
Empl
Grads Employed in
8
Field
165
100
31
21
14
Annual Salary & Wages Reported Graduates Employed in the Field

Less than
$25,001$30,001
Greater
Student not
$25,001
$30,000
-$35,000
than
Reporting
$35,000
Salary
0
5
4
5
17
0
4
1
5
11
Students are entitled to a list of the objective sources of information used to substantiate the salary disclosure. To obtain this list, please ask an institutional
representative where to view this list.
Version 2015.02.20
Page 10 of 27

FEDERAL STUDENT LOANS

The Coho t Default ate CD ep ese ts the pe e tage of this i stitutio s stude ts that failed to ake e ui ed
payments on their federal loans within three years of when they were required to begin repayment of that loan. The
most recent three-year cohort default rate reported by the U.S. Department of Education for this institution is 0%.
The percentage of the students who attended this institution in 2013, who received federal student loans to help pay
their cost of education at the school was 90.35%.
This fact sheet is filed with the Bureau for Private Postsecondary Education. Regardless of any information you may have relating to completion
rates, placement rates, starting salaries, or license exam passage rates, this fact sheet contains the information as calculated pursuant to state law.
Any questions a student may have regarding this fact sheet that have not been satisfactorily answered by the institution may be directed to the
Bureau for Private Postsecondary Education at: P.O. Box 980818, West Sacramento, CA 95798-0818, www.bppe.ca.gov, P: 888.370.7589 or
916.431.6959, F: 916.263.1897.
I have read and understand this School Performance Fact Sheet. The School Performance Fact Sheet was reviewed and discussed with a school
official prior to signing an enrollment agreement.
Sandy Hernandez
Student Name - Print
s:a:r
[04/15/2015
d:a:r
Student Signature
Date
School Official Signature
Date
Definitions:
Nu e of tude ts Who Bega P og a
ea s the number of students who began the program who are scheduled to complete the program
within the reporting calendar year.
tude ts a aila le fo g aduatio is the u e of stude ts ho ega p og a
i us the u e of stude ts ho ha e died, been
incarcerated, or been called to active military duty.
G aduates is the u e of stude ts ho o pleted the p og a
ithi
% of the p og a le gth.
Co pletio ate is the u e of G aduates di ided the Nu e of tude ts A aila le fo G aduatio .
5
% G aduates is the u e of stude ts ho o pleted ithi
-150% of the program length.
% Co pletio ate is the u e of stude ts ho o pleted the p og a i the epo ted ale da ea ithi
-150% of the published
program length divided by the Number of Students Available for Graduation in the published program length period.
G aduates a aila le fo e plo e t ea s the u e of g aduates i us the u e of g aduates u a aila le fo e plo e t. G aduates
u a aila le fo e plo e t
ea s the g aduates ho, afte g aduatio , die, e o e i a e ated, a e alled to a ti e ilitary duty, are
international students that leave the United States or do not have a visa allowing employment in the United States, or are continuing their
education in an accredited or bureau-approved postsecondary institution.
G aduates e plo ed i the field
ea s g aduates ho a e gai full e plo ed i a si gle positio fo hi h the i stitutio ep ese ts the
program prepares its graduates within six months after a student completes the applicable educational program. For occupations for which the
state requires passing an examination, the period of employment must begin within six months of the announcement of the examination results
for the first examination available after a student completes an applicable educational program.
Pla e e t ate E plo ed i the Field is al ulated
di idi g the u e of g aduates gai full e plo ed i the field
the u e of
graduates available for employment.
10 Number of Students Taking Exam is the number of students who completed the program within 150% of the published program length and
who took the exam in the reported calendar year for the first time.
11 Exam Date is the date for the first available exam after the students completed the program.
12 Passage Rate is calculated by dividing the number of students who passed the exam by the number of graduates who took the reported
licensing exam.
13 Number Who Passed First Exam Taken is the number of students who took and passed the licensing exam in the reported calendar year on the
first attempt.
14 Salary is as reported by the student. Not all graduates report salary. A list of the employers of the Graduates Employed in the Field can be
obtained from Unitek College Career Services Department.
Version 2015.02.20
Page 11 of 27

STUDENT EMERGENCY/CONTACT FORM

STUDENT INFORMATION
Name
Sandy Hernandez
Street Address
1120 sherman st
Primary Contact Number
408-781-8420
Email Address:
sandyhernandez74@gmail.com
US Resident Contact
Name
[
Street Address
[
[
Email Address:
[
Medical Emergency Contact
Name
[ Greg Carbajal
Street Address
[ 1120 Sherman st
[ 4083934147
Email Address:
[
t:a:o
t:a:o
t:a:o
Other Names (if any)

[
t:a:o
City
State
San Jose
CA
Secondary Contact Number
[
t:a:o
Zip
95110
Relationship
[
t:a:o
City
State
[
t:a:o
][
t:a:o
[
t:a:o
Zip
t:a:o
]
][
t:a:o
t:a:r
t:a:o
t:a:r
]
Relationship
[ boyfriend
t:a:r
City
State
[san jose
t:a:o
] [ca t:a:o
[
t:a:o
]
Zip
] [95110t:a:o
]
]
t:a:o
Program Enrolled In: Vocational Nursing

Program Time:
Evening
Current Mobile Number:
[ 4087818420
Service Provider:
t:a:r
[ verizon
t:a:r
Acknowledgement of mandatory SMS phone number for emergency notifications:

SMS (Short Message Service via mobile text) will be used for emergency notifications. This mandatory campus safety measure requires all active
students of Unitek College to maintain a valid cell phone number on file.
By signing below I assert that I have provided a current and active mobile phone number on this Emergency Contact form, and I acknowledge my
responsibility to update and maintain a current/active mobile phone number while attending Unitek College.
[
[04/15/2015
d:a:r
]
Sandy Hernandez
Student Name
s:a:r
Student Signature
Version 2015.02.20
Date
Page 12 of 27

(FERPA) STUDENT RECORD RELEASE FORM

Student Name: Hernandez, Sandy,
(Last Name, First Name, M.I.)
Student Number: 209989
Program: VN Pre-Requisite
My records may be released to only the following individuals:
t:a:o
][
t:a:o
][
t:a:o
][
t:a:o
t:a:o
t:a:o
(Relationship to Student)
t:a:o
][
t:a:o
t:a:o
t:a:o
][
I hereby consent freely and voluntarily to the disclosure, inspection, and copying of information and documents relating to my financial aid,
credentials, qualifications, and performance with Unitek College to the individuals in the above list. This release form shall remain in effect
throughout my enrollment at Unitek College.
s:a:r
Student Signature:
Date: [04/15/2015
d:a:r
School Official Name
Registrar
Title
Date
Version 2015.02.20
Page 13 of 27

PROGRAM ENROLLMENT FORM CHECKLIST

I understand the information provided and presented to me in the following documents:
Program Enrollment Agreement

Agreement to Binding Arbitration
All-Inclusive Tuition Opt Out Waiver
Prior to signing this Program Enrollment Agreement, I have reviewed and accepted the following items as part of the Admissions Application:
School Catalog
Background Check Authorization Form
Student Emergency Contact Form
FERPA Records Release Form
Program Immunization Requirements
School Performance Fact Sheet
GED/High School Diploma Attestation
Credit Granting Request Form
Program Passing Assistance Form

Program Physical Examination Form
Before confirming registration, the following items must be submitted to Unitek College:
Proof of High School / GED or Equivalent

Government Issued Valid Photo ID
Admissions Application
I acknowledge receipt of all documents listed above.

[
s:a:r
Sandy Hernandez
Student Name
Student Signature
[04/15/2015
d:a:r
]
Date
Nick Marsh
Admissions Rep Name
Admissions Rep Signature
Date
Version 2015.02.20
Page 14 of 27

BACKGROUND CHECK AUTHORIZATION FORM

Course: Licensed Vocational Nursing Program
Date: _April 14, 2015______
Start Date: _ 07/13/2015______________
Location: _ Fremont __________
I, Sandy Hernandez, authorize Unitek College to perform a complete background investigation for the past 7 years. This
background investigation includes a criminal search and social security trace.
Full Legal Name: [Sandy
t:a:r
] [
] [Hernandez
t:a:r
t:a:o
First, Middle & Last
33 [6116
t:a:r ] [t:a:r]
t:a:r ]
Social Security Number: [545
(xxx-xx-xxxx)
Drivers License or State ID Number: [ b3352259
t:a:r
Addresses for last 7 years (please list County):

1. 1120 sherman st, San Jose, CA, 95110, [usa
t:a:r
] County
(Address, City, State, Zip, County)
2. [
1015 Byers st Gilroy, Ca 95020

t:a:o
3. [
860 E Central Ave Morgan Hill,

Ca 95037
t:a:o
05/04/1974
Date of Birth:
(Month/ Day/ Year)
Please list any alias or former names: [

Criminal Report:
SST:
Sandy Hernandez
Student Name
t:a:o
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 15 of 27

EDUCATIONAL REQUIREMENTS - VOCATIONAL NURSING PROGRAM

All students must show proof of their High School Diploma, GED or equivalent in order to complete the enrollment process and be
officially approved to start the program.
Students must provide proof in one of the following formats:
1. Copy of a United States High School Diploma or Official Transcript from a state approved or United States Department of
Education approved school.
2. Copy of a GED Certificate
3. Cop of a Asso iate s Deg ee o tai ed f o a U ited tates Depa t e t of Edu atio A edited s hool
4. Copy of a Bachelors Degree obtained from a United States Department of Education Accredited school
5. Masters Degree obtained from a United States Department of Education Accredited school
6. A foreign High School Transcript, Associates Degree Transcript, Bachelors Degree Transcript, Masters Degree Transcript that
has been evaluated to be the equivalent of a United States High School Diploma
Foreign Transcripts - Translation and Evaluation Requirements

For MA, PT and VN Program Applicants: All students providing a foreign proof of education or transcripts for
credit granting must be evaluated by an accepted evaluation service, before completing the enrollment process.
Unitek College will only accept evaluations completed by members of the National Association of Credential
Evaluation Services or Academic and Credential Records, Evaluation and Verification Services.
National Association of Credential Evaluation
Services (NACES)
Academic & Credential Records, Evaluation and

Verification Services (ACREVS)
www.naces.org
1776 Clear Lake Avenue, Milpitas, CA 95035

Phone: (408) 719-0015 (510) 252-0876
Please visit website for list of approved

services.
Email: info@acrevs.com
www.acrevs.com
For RN and BSN Students: LVN to RN or RN to BSN applicants wishing to submit their foreign Associates Degree
T a s ipt, Ba helo s Deg ee T a s ipt, Maste s Deg ee T a s ipts o t a s ipts fo the e ui ed p e e uisites
must have them evaluated by the Commission on Graduate of Foreign Nursing Schools. All foreign transcripts
evaluated by any other evaluation service will not be accepted as part of the enrollment process.
Commission on Graduate of Foreign Nursing Schools (CGFNS)
3600 Market Street, Suite 400, Philadelphia, PA 19104-2651
(215) 222-8454
www.cfns.org
Student understands and agrees that by signing this acknowledgement that student will submit proof of high school education or
higher evaluated by an approved evaluation service and takes full responsibility to provide the correct proof of documentation
requested. Student also understands that should they not provide satisfactory documentation at the time of application, they may
forfeit the privilege of starting the program, even if student has met all other admissions criteria. Student also understands and
acknowledges that Unitek College will not pay the fees that may be incurred by student in order to submit such proof.
STUDENT ACKNOWLEDGES RECEIPT AND EXPLANATION OF ADMISSIONS CRITERIA OUTLINED ABOVE.

[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 16 of 27

GED/HIGH SCHOOL DIPLOMA ATTESTATION
I, Sandy Hernandez_____, do hereby certify that I completed or earned my

(Print Full Name)
GED or High School diploma from, _[ CET
t:a:r
]___.
(School Name)
In the state of _[ca
t:a:r
]_, city of _[Gilroy
t:a:r
(State)
In the year of _[July
t:a:r
]_.
(City)
]/[1993 t:a:r
]_.
(month/year)
By signing below I certify that the foregoing information is true to the best of my ability and that if the
necessary documentation is not submitted prior to the start date my enrollment may be terminated without
further notice from the school.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 17 of 27

PROGRAM ADMISSION REQUIREMENTS

ADMISSION TO PREREQUISITES PROGRAM
All prospective vocational nursing students shall be chosen without regard to race, color, religion, gender or national origin.
1.
2.
3.
Ad issio to U itek College s Vo atio al Nu si g P og a is ased o a hie i g a passi g s o e i the Wonderlic SLE
entrance exam. All prospective students for the Vocational Nursing program are required to take the SLE exam. A satisfactory
score in this test will enable the student to enroll into the pre-requisites course and, upon successful completion, become
eligible for the core program. To be eligible to enroll in the prerequisite program, students must achieve a score of 19 or
higher.
Upon successfully passing the SLE exam, students must undergo a personal interview, by appointment, with the Program
Director or Designee (interviews will be scheduled prior to the start of the prerequisites program start). Each student is
required to provide the following documentation prior to the time of the interview:
a. Sealed Official Transcripts for Credit Granting (if official transcripts are not submitted at the time of application,
student forfeits the opportunity to apply for credit granting on courses taken previously).
b. Physical Examination Form and Copies of their immunization and titers.
The following must be complete and submitted prior to attending the prerequisite program:
a. High school diploma or equivalent
b. Copy of Government Issued Photo ID
c.
Payment of all fees & tuition.
d.
*Physical examination by licensed physician or Advanced Nurse Practitioner establishing sound health (including
immunizations).
*Required by the start of the final week of the prerequisite program.

ADMISSIONS TO CORE PROGRAM
Pre-requisite course must be completed successfully and all criteria for admissions must be met in order to be eligible to be
admitted to the Core programs. Once inducted into the Core program, you will receive an acceptance letter confirming your
admission.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE TERMS FOR ADMISSION INTO UNITEK COLLEGE VOCATIONAL
NURSING PROGRAM.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 18 of 27

VN CORE SELECTION & ACADEMIC POLICIES

SELECTION INTO VN CORE PROGRAM (UPON SATISFACTORY COMPLETION OF PREREQUISITE)
1.
The students who passed the pre-requisites with the highest grade and who score the highest points in the interview will be
given core seats available. In case two or more students have the same grades in the pre-requisites, points assigned in the
interview will be utilized to make the final student selection for core seats.
2.
Students who have successfully completed the pre-requisites but did not receive a core seat in the initial start date, and have
met all of the admission criteria will be assigned core seats in the next available Vocational Nursing program.
ACADEMIC POLICIES Readmission or repeating a course

For any repeated courses, students will be required to pay the training costs associated with the hours the student is repeating. For
example, if you fail a course that is 31 hours of instruction in semester 1, but pass all other courses, you will only be required to pay
100% of total cost associated to the 31 hours. You are not required to retake a course that you have successfully completed with an
average of 75% or higher.
1.
The Program Director approval is required prior to readmissions.
2.
After approval for readmission is received from Program Director, a Change of Status must be processed with Admission
Director, and an updated enrollment agreement must be signed.
3.
Student cannot repeat course until payment has been received by accounting.
4.
Students may repeat a course no more than ONE time (total two attempts). All grades received will appear on the transcript,
and are counted in the cumulative grade point average (GPA).
5.
Courses taken at institutions other than Unitek College do not affect the grade point average.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE TERMS FOR RE-ADMISSION INTO UNITEK COLLEGE
VOCATIONAL NURSING PROGRAM.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 19 of 27

SELECTION, ELIGIBILITY AND REGISTRATION - VOCATIONAL NURSING CORE PROGRAM

CORE Eligibility
Students become eligible for enrollment into the LVN CORE program upon passing the Prerequisite program with a grade of 75% or
better.
CORE Selection
At the conclusion of the Prerequisite program, students eligible for CORE enrollment are selected to receive enrollment priority for
the associated CORE start date and campus. Selection for CORE enrollment priority is based on the grade rankings and interview
points among students from that specific prerequisite program start date.
In cases were two or more students have the same grades in the Prerequisite program, points assigned in the entrance interview will
be utilized to make the final student selection for CORE.
CORE Registration/Enrollment
Selected students must enroll for the associated CORE start date within three (3) business days following notification of selection. If
a selected student does not enroll for the associated start date within the three-day period, or, if the student provides written
notification to the school that he/she wishes to cancel or postpone enroll e t, the stude t s seat i the asso iated COE sta t date
will be made available to the next eligible student.
A student eligible for CORE enrollment but not notified of selection for enrollment into the associated CORE start date will be
assigned a CORE seat in the next available CORE start date at that campus. If a student is selected for CORE enrollment after the
three-day priority enrollment period, and the student chooses to postpone enrollment, the student will not be assigned a seat in the
next CORE start date. The student must wait for enrollment selection following the next Prerequisite program.
Required for CORE Enrollment:
1.
Signed CORE Program Enrollment Form
2.
$150 CORE Registration Fee
CORE Postponement
Students eligible for CORE enrollment who wishing to postpone enrollment for the associated CORE start date are advised that their
enrollment for a specific future CORE start date is not guaranteed until the conclusion of the Prerequisite program associated with
the desired CORE start date. At that time, the student will be notified of the seating availability and given the opportunity to enroll.
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE TERMS FOR RE-ADMIION INTO UNITEK COLLEGE
VOCATIONAL NURSING PROGRAM.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 20 of 27

UNITEK COLLEGE PASSING ASSISTANCE

1.
Prior to Completion of the VN Program: For students registered in the Vocational Nursing (VN) program, at the end of the
third semester, Unitek College offers an online exam that assists with and predicts the probability of passing the National
Council Licensure Examination for Practical Nurses (NCLEX) national exam.
2.
Licensing Application Forms & Fees: Upon successful completion of the Vocational Nursing program, Unitek College will pay
for and facilitate the students with the licensing application process.
3.
Please note that you must meet the following criteria before Unitek College can submit your application for licensure:
4.
a.
Completion of all courses with 75% or higher in order to progress to the next semester.
b.
Completion of all proctored exams, inclusive ATI Comprehensive VN Exam (ATI PN)
c.
Completion of Remediation for all course content exams below a 75%.
d.
Co pletio of a Co p ehe si e P edi to p o to ed e it e a

ith a % o highe o the P edi ted P o a ilit
of Passing the NCLEX-PN o the Fi st Atte pt . If a s o e of % o higher is not achieved on the Comprehensive
Predictor Examination, student will be required to complete a remediation plan/ review of content prior to taking
the exit exam for a second time within 60 days of completing the nursing curriculum. Student is allowed a
maximum of two attempts at the exit exam.
e.
Students completing all courses successfully and completing all the required hours, but who have not successfully
passed the ATI exit exam, will be allowed to participate in the pinning ceremony, but will not be allowed to
participate in the graduation ceremony. Students will not receive diplomas or certificate of completion and
submission of student applications for licensure exam will be delayed until all criteria have been met
f.
Students in the VN program not successfully achieving a 90% probability score on the second attempt at the ATI
exit exam have not completed the criteria for successful exit from the nursing program; will not receive a diploma
or certificate of completion, and student applications for licensure exam will not be submitted. Students will have
to apply for readmission for the Professional Development course in their last semester and audit all med/surg
courses before attempting retake of exit exam.
Taking the NCLEX Exam: Upon notification from the Board of Nursing that a student is eligible to take the licensing exam,
the student is responsible for registering for the exam. Student can register for this exam online or by mailing in the
application with the fees the first exam must be taken within 90 days of graduation in order to qualify for the
reimbursement. If the student does not pass the exam on the first attempt, Unitek College will pay for retake of the exam
(the second attempt must be taken 90 days after the first exam but no later than 240 days [8 months] of original graduation
date with the following stipulations:
a.
Student must schedule tutoring with Program Director or Assistant Director OR
b.
Must show proof of exam preparation through another agency
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THE ABOVE GUIDELINES AND CRITERIA FOR LICENSING PREPARATION.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 21 of 27

IMMUNIZATION REQUIREMENTS - VOCATIONAL NURSING/REGISTERED NURSING

The following are the immunizations required by current clinical facilities. These immunizations assist in decreasing risks and
ensuring student and patient safety.
All students must provide proof of immunization prior to starting the core curriculum and of the Vocational Nursing or Registered
Nursing programs.
I, _Sandy Hernandez_______, will bring in the following documentation to my admissions representative prior to the start of the
core curriculum.
1.
2.
3.
4.
5.
6.
7.
8.
Physical Examination form

Positive MUMPS, MEASLES and RUBELLA titer. If negative, 2 MMR vaccinations (given 4 8 weeks apart), must be followed
by a titer after last vaccination
Positive VARICELLA titer. If negative two Varicella immunizations (given 4-8 weeks apart), must be followed by a titer after
last vaccination. A history of chicken pox does not satisfy this requirement
Positive HEPATITIS B surface antibody titer. If negative, three Hepatitis B vaccines completed, must be followed by a titer
after last vaccination
Tdap/DTAP with 10 years
Whooping Cough booster if Pertussis missing. Students may sign declination however they must be informed that if required
by clinical facility they may not be placed and may not be able to complete the program.
Flu and H1N1 immunization or signed waiver. Student must be advised that if required by clinical facility they may not be able
to be placed, which in turn may result in them not being able to complete the program.
TB screen
a.
2 step PPD Skin Test or QuantiFERON Blood test (2 step PPD, 2 separate tests minimum of 10 days and a max of 30
days apart max)
b.
If PPD positive, must get a Chest X-Ray; CXR yearly after initial
Student understands , by signing this acknowledgement, student agrees to submit items per description above, and takes full
responsibility to provide proof of a documentation requested. Student understands that should they not provide satisfactory
documentation by the first day of Core, stude t ill fo feit the p i ilege of sta ti g U itek College s Vo atio al Nu si g/egiste ed
Nursing Programs, even if student has met all other criteria. Student also understands and acknowledges that Unitek College does
not pay the fees that may be incurred in order to submit such proof.
I ACKNOWLEDGE RECEIPT AND EXPLANATION OF THE PREVIOUSLY OUTLINED IMMUNIZATION REQUIREMENTS.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 22 of 27

(TO BE COMPLETED AND SUBMITTED BY STUDENT)

PHYSICAL EXAMINATION FORM - VOCATIONAL NURSING / REGISTERED NURSING
Instructions: Please have your physician (MD) or family nurse practitioner (FNP), complete every question. Incomplete forms will
not be accepted.
To the healthcare providers: This form is used to screen for current and potential health risks that may interfere with the
appli a t s a ilit to t ai safel i the Li e sed Vo atio al Nu si g P og a . This appli a t ill e e pe ted to sta d, sit, and walk
for long periods of time, in addition to physically lifting and transferring 25 to 50 pounds. If you have any doubts about whether this
applicant would be able to meet these requirements, please make a note on the form. A epta le otatio s i lude WNL , OK ,
o EE BELOW .
Full Name
Height
Date of Birth:
Weight
Hearing
Teeth
Temperature
Lungs
Sex:
Resp
Glands
Male
B/P
Pulse
Ears
R
Skin
Spine
L
Neuro
Extremities
Vessels
Abdomen
Pelvis
Inguinal Rings
Breasts
Menstrual Hx
Pregnant
A e the e a e otio al o e tal health o side atio s that ould i pa t tude t s a ilit to pe fo
No
Yes (please explain)
nurse?
Have any allergies?
No
Female
the ole of a li e sed vocational
Yes (please explain)
TB skin test #1 & 2 (two-step), if positive, must have chest x-ray: Results:
This applicant is free of communicable disease?
Yes
No (please explain)
Additional comments or remarks:
Printed Name:
Date:
Authorized Signature:
Title:
Student Name: Sandy Hernandez
i:a:r ]
Student Initials: [sh
Version 2015.02.20
Date: _[04/15/2015
d:a:r
]__
Page 23 of 27

(STUDENT COPY) TB ANNUAL SYMPTOM REVIEW

(Required for everyone regardless of outcome)
Student Name:
Sandy Hernandez ________
Date of Birth:__05/04/1974_
Date:
April 14, 2015
Last 4 of Social Security #: _[6116

t:a:r ]
Program:
Licensed Vocational Nursing
This questionnaire is required for all students and faculty as part of their annual TB screening. Please note if further follow-up is
required, your healthcare provider must specify the plan of care below (Part 2). You should keep a copy for your files at home.
PART 1: (Please complete prior to seeing Health Care Provider)
TB Symptoms Review
1.
Are you currently exhibiting any of the following

symptoms of tuberculosis?
Cough lasting longer than 3 weeks
Yes
No
Coughing up blood
Yes
No
Fever
Yes
No
Weight loss
Yes
No
Night sweats
Yes
No
Have you had any of the following within the last 12 months?
Yes
Yes
Yes
Yes
No
No
No
No
Yes
No
If the a s e is Yes to a of the s pto s listed a o e, please state he s

have occurred; and if patient has been evaluated by physician for symptoms.
pto s fi st ega ; ho lo g s
pto s
2.
Yes
No
Is any person living in your household exhibiting any symptoms of tuberculosis that are listed above? If
the lie t a s e ed Yes , please list the s pto s.
3.
Yes
No
Have you ever has a chest x-ray done to rule out tuberculosis? If the client answe ed Yes , please state
when the chest x-ray was done; the name of the physician; and the address and phone number of the physicians/agency
where it was done.
4. Yes
No
Have you ever received medication for active tuberculosis disease or preventive treatment for TB
i fe tio ? If the lie t a s e ed Yes , please state a e of ediatio s; he the edi atio as sta ted a d o pleted.
Student Signature
Date
Part 2 (Completed by Physician or Nurse Practitioner):

Printed/Typed Name of Health Provider (or legible stamp), indicating name/title:
Health Care Agency affiliation:
(city/state)
By signing this form I attest that the symptoms were reviewed. If further action is required I have so noted.
Signature of Health Care Physician/Nurse Practitioner:
Date
Any further follow-up, other than annual review questionnaire, in 12 months
Version 2015.02.20
Page 24 of 27

CREDIT GRANTING REQUEST FORM (SCHOOL OF NURSING AND ALLIED HEALTH)

Note: All Veterans must submit all transcripts for review.
Guidelines and Requirements:

1.
2.
3.
4.
5.
6.
7.
8.
Academic credit earned for courses appearing on an official transcript from a regionally or nationally accredited
e tifi ate/deg ee g a ti g s hool, ollege o u i e sit ith a i i u g ade of C . o a . s ale ill e e aluated
according to Unitek College policies and subject to approval by the Program Director.
Credit may be given for related previous education from an accredited institution completed within the last five (5) years.
Transfer credits based on a different unit of credit than the one prescribed by Unitek College are subject to conversion before
being transferred. Credit granting for paired courses must meet the requirements for both courses.
Course evaluations based on official transcripts by the Program Director are final. Any preliminary reviews by campus
personnel are unofficial and not binding, and subject to change.
The maximum of credit allowed towards any CORE program is 30% of total program units/hours. Students must complete
70% of the program at Unitek College to be awarded a certificate of completion or degree.
A maximum of 12 credits may also be awarded for successful completion of exams from approved national testing programs
(Advanced Placement Exams [AP], College Level Examination Program [CLEP], DANTES[DSST]), according to Unitek College
policy.
Credit may be granted for the following:
a. Successful completion of vocational/practical nursing courses.
b. Successful completion of registered nursing courses.
c. Successful completion of armed services nursing courses.
d. Successful completion of other courses that are equivalent to courses in the program as determined by the director
of the program.
No credit shall be granted for partial courses. Students may also be requested to provide a detailed and official course
description; this can be obtained from the programs catalogue in most cases. Credit may be granted for clinical skills based on
competency check.
Grades and Auditing Following Credit Granting:

1.
2.
Grade for courses edited, ega dless of g ade a hie ed fo edited ou se o k, ill e a CG to efle t edit g a ted.
This will not be counted toward GPA.
Students are permitted and encouraged to audit courses credited. In some cases, students may be required to audit (attend
all class sessions).
Submission Instructions & Deadline: Official sealed transcripts must be submitted to the Registrar/Program Director for
review before the end of the first week of the prerequisite program.
Please mark the appropriate statement with a check mark to indicate appropriate request.
Regular Students
1.
2.
I am submitting evaluation request for transfer of credit for courses completed.
X I waive credit granting and will attend all portions of the program.
[c:a:r]
Veteran Students
1.
_____ I understand as a veteran I must, and I am, submitting all prior education and experience for evaluation for credit
granting.
P i ted Na e_______________________________________________
Program Director Initials: ____________________
Version 2015.02.20
Vete a : Yes No
Student Initials: [sh

i:a:r ]
Page 25 of 27

REFER A COLLEAGUE, FRIEND OR FAMILY MEMBER

Congratulations on your provisional acceptance into Unitek College! Here is your chance to help someone close to you
take the next step forward. Many of our most successful graduates would not have known about Unitek College without
the help of a friend or loved one.
List the name and phone number of the people you wish to help, and your Admissions Representatives will help them
get started!
Name:_ [
t:a:o
]_ Phone: _[
t:a:o
]_
Name: _ [
t:a:o
]_ Phone: _[
t:a:o
]_
Name: _ [
t:a:o
]_ Phone: _[
t:a:o
]_
Name: _ [
t:a:o
]_ Phone: _[
t:a:o
]_
Student Name (Please print): _Sandy Hernandez____ Date: __[04/15/2015

d:a:r
]__
Admissions Representative Name: _ Nick Marsh __________________________________
Version 2015.02.20
Page 26 of 27

BOOK AND SUPPLY LIST - VOCATIONAL NURSING PREREQ & CORE

VN Prerequisite Book Description
Medical Terminology for Health Professions (Ehrlich)
Dosage Calculations (Pickar)
Edition
7th
9th
ISBNs
978-1-133-71666-2
978-1-111-31959-5
VN CORE Book Description

Pharmacological Aspects of Nursing Care (Broyles)
Foundations of Nursing Textbook (Christensen)
Foundations of Adult Health Nursing Textbook (Christensen)
Foundations of Nursing Study Guide (Christensen)
Foundations of Adult Health Nursing Study Guide (Christensen)
Mosby's Diagnostic and Laboratory Test Reference (Pagana)
Saunder's Comprehensive Review for NCLEX-PN (Silvestri)
Mosby's Nursing PDQ for LPN (Mosby)
Mosby's Drug Guide (Skidmore-Roth)
Mosby's Dictionary of Medicine (Mosby)
BLS for Healthcare Provider Manual with CD
Edition
8th
6th
6th
6th
6th
11th
5th
3rd
10th
9th
N/A
ISBNs
978-1-111-31935-9
978-032-305-7325
978-032-305-7363
978-032-305-7356
978-032-305-7394
978-032-308-4680
978-145-570-3791
978-032-308-4475
978-032-308-6431
978-032-307-4032
90-1038
Supplies Description
Medical Supply Kit
For the most current book listings by program section please visit:
http://www.unitekcollege.edu/programs/vocational-nurse/book-list
Book and supply listings may also be obtained from the Unitek College Student Services Department.
Acknowledgement of changes to book and supply listings for students electing to opt-out of all-inclusive program
tuition:
Changes to book listings, including, but not limited to, changes to required edition numbers, publishers, authors or titles,
may occur as necessary. These changes may be made at any time prior to the start of the program. Students electing to
opt-out of all i lusi e tuitio fo ooks a d supplies a e espo si le fo e su i g that all ooks a d supplies
purchased match the most current required book and supply listings.
By signing below I certify that I understand the above policy for book and/or supply purchasing if I elect to opt of allinclusive tuition.
[
Sandy Hernandez
Student Name
s:a:r
[04/15/2015
d:a:r
]
Student Signature
Version 2015.02.20
Date
Page 27 of 27
ENROLLMENT SUBMISSION CHECKLIST: VOCATIONAL NURSING PREREQUISITE
Student Name: Sandy
Hernandez
First
Start Date: 07/13/2015
Middle
Last
Campus: Fremont
Rep Name: Nick Marsh
Agency:
Rep Initials
Document Name
Comment
1. COPY - Enrollment Agreement First Page

2. Enrollment Agreement
Disclosures/Application Forms
3. BACKGROUND CHECK AUTHORIZATION FORM
4. EDUCATIONAL REQUIREMENTS
5. CORE SELECTION, ELIGIBILITY AND REGISTRATION
6. GED/High School Diploma Attestation
7. ADMISSION REQUIREMENTS
8. VN CORE ADMISSIONS & ACADEMIC POLICIES
9. PASSING ASSISTANCE
10. IMMUNIZATION REQUIREMENTS - VN/RN
11. PHYSICAL EXAMIINATION FORM - VN/RN
12. Credit Granting Request Disclosure
13. Credit Granting Request Submission Form
14. STUDENT EMERGENCY/CONTACT FORM
15. FERPA/STUDENT RECORD RELEASE FORM
16. Referral Form
17. Book/Supply Listing (Opt-out Acknowledgment)
Required Submissions
18. Assessment Proctor Score Sheet
19. Photo ID (COPY)
20. POG - HS Diploma/GED Proof of Graduation
21. $150 Reg Fee Receipt
Agency Student
Reg Fee + Books charged to agency student. All other prereq charges credited.
_____________________________________
Admissions Representative Signature
_____________
Date
_____________________________________
_____________
Date
INTERNAL USE ONLY
BWZEH8JHR4LUGP2GMEJSFB
Sandy Hernandez
Party ID: 6YGS8MJJXK4IDZBK3DYP8F
IP Address: 70.197.19.46
VERIFIED EMAIL:
Multi-Factor
sandyhernandez74@gmail.com
Digital Fingerprint Checksum
0e9a8f00b5fe4a22de5818783112056d356065e5
Timestamp
Audit
2015-04-15 10:50:26 -0700
All parties have signed document. Signed copies sent to: Nick marsh, Sandy
Hernandez, and Nick Marsh.
2015-04-15 10:50:25 -0700
Document signed by Sandy Hernandez (sandyhernandez74@gmail.com) with drawn

signature. - 146.74.216.98
2015-04-14 20:57:19 -0700
Document viewed by Sandy Hernandez (sandyhernandez74@gmail.com). 70.197.19.46
2015-04-14 14:29:45 -0700
Document created via the RightSignature API by Nick Marsh

(nickm@unitekcollege.edu). - 40.129.185.4
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UNITEK COLLEGE 888 735.4355 | www.unitekcollege.

VOCATIONAL NURSING PREREQUISITES PROGRAM ENROLLMENT AGREEMENT

April 14, 2015

STUDENT NUMBER: 209989

STUDENT NAME (LAST, FIRST): Hernandez, Sandy

HOME TELEPHONE #: 408-781-8420

EMA IL: sandyhernandez74@gmail.com

Vocational Nurse Pre-Reqs

Pre-Req Duration Hours: 80

TUITION & FEES

Pre-Req Start Date:

Pre-Req End Date:

Student Tuition Recovery Fund:

1 week Tuesday Friday

Class Days and Time:

TOTAL TUITION FOR ENTIRE PROGRAM: $ 3,150.00

** = NON REFUNDABLE IF USED

Admissions Representative: Nick Marsh

APPROVED BY SCHOOL OFFICIAL:___________________________________________________________ DATE:_______________________ ___

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

You are not a California resident.

Califo ia s Bu eau fo P i ate PostPage 3 of 27

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

*Not all programs offer distance education courses

Copyright Unitek College

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

Admission Representative (Print Name): Nick Marsh

Admission Representative (Signature):

Approved by School Official (Signature):

Copyright Unitek College

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

STUDENTS RIGHT TO CANCEL

TUDENT RIGHT TO REFUND

Copyright Unitek College

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

WITHDRAWAL FROM THE PROGRAM

Copyright Unitek College

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

AGREEMENT TO BINDING ARBITRATION AND WAIVER OF JURY TRIAL

The a it ato s de isio shall e set fo th i

iti g a d shall set fo th the esse tial fi di gs a d o lusio s upo

PROCEDURE FOR FILING ARBITRATION

School Official Signature: ________________________________________________ Date:____________ ____________

Copyright Unitek College

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

ALL-INCLUSIVE TUITION OPT OUT WAIVER

X I DO NOT wish to opt out of books and supplies.

If electing to opt out:

I wish to opt out of the books and supplies.

Purchasing Books & Supplies POLICY:

Copyright Unitek College

UNITEK COLLEGE 888 735.4355 | www.unitekcollege.edu

Student Performance Fact Sheet - 2012 & 2013

Number of Students Who Began Program

Students Available for

Completed in 101% to 150%

Number of Students Who Began

Students Available for

License Examination Passage Rates (continually administered tests)

Salary and Wage Information

Grads Avail for

APPROVED BY SCHOOL OFFICIAL:_______________________________________ DATE:_ _

School Official Signature: ____________________________________ Date: