Enrollment Agreement - Patient Care Technician
 
Personal Identifiable Information

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TN Professional Training Institute Enrollment Agreement

Patient Care Technician - Clinical Patient Care Technician

1630 S. Church Street, Suite 302 Murfreesboro, TN 37130

615.631.8440 - www.TNPTI.com - info@tnpti.com




Registration Date:


 

Student's First Name:

Middle Initial:

Last Name:

Social Security Number:

DL #:

DL State:

Date of Birth:

 

Race:

Gender:

Student Address:

City:

State:

Zip:

Telephone Number:

Email Address:

High School Name:

If you did not see your high school listed in the dropdown above, please enter the name of your high school:

City of High School:

State of High School:

Graduation Date:

 
Pre-enrollment Checklist:
 Please initial each section when completed

Complete the in person or virtual tour of TN Professional Training Institute. 

Received an institutional catalog and if provided electronically, understands that the student may request a hard copy of the catalog at any time. 

Was given the time and opportunity to review the institutional policies in the catalog.

Knows the length of the program for full- time and part-time students in academic terms and actual calendar time. 

Has been informed of the total tuition and other fees of the program. 

Has been informed of the estimated cost of books and any required purchases.

Has been given a copy of the institutional refund policy.

Has executed a Transferability of Credits Disclosure Statement in compliance with Tenn. Code Ann. 49-7-14 and understands the specific limitations should the institution have articulation agreements. 

Understands that any person claiming damage or loss as a result of any act or practice by this institution that may be a violation of the Title 49, Chapter 7, Part 20 or Rule Chapter 1540-01-02 may file a complaint with the Tennessee Higher Education Commission, Division of Postsecondary State Authorization (DPSA) after exhausting the grievance process at the institution. DPSAs address is 404 James Robertson Pkwy., Parkway Towers Suite 1900, Nashville, TN 37243 and the telephone number is (615) 741-5293.

Signature of Student:

Date:

 
Student Information:

Student's First Name:

Middle Initial:

Last Name:

Address: 

City:

State:

Zip:

Telephone Number:

Email Address: 

Employer Information:

Employer's Name:

Employer's Address: 

City:

State:

Zip: 

Telephone Number:

Emergency Contact:

(1) First Name:

Last Name:

Phone Number:

Relationship: 

(2) First Name:

Last Name:

Phone Number:

Relationship:

Physicians Name:

Phone Number:

 I have voluntarily provided the above contact information and authorize TN Professional Training Institute and its representatives to contact any of the above on my behalf in the event of an emergency. 

I give consent and authorize TN Professional Training Institute and its representatives to call emergency services on my behalf in the event it should it be needed. If services are required school is not responsible for medical costs. 

Signature of Student:

Date:

 
TN Professional Training Institute Enrollment Agreement

TN Professional Training Institute Enrollment Agreement 

Patient Care Technician - Clinical Patient care technician



Program Title: Patient Care Technician- (4 weeks)

Circle Status:


Projected Start Date

 

Projected Date of Completion:

 

Program Length: 160 HOURS

(Initial) I understand that I am enrolling in a 160 hr program beginning on the start date listed above and completing on the end date listed above.

(Initial) I understand that the total cost of the program is $4600 which includes all equipment, materials and fees with the exception of scrubs and textbook.

(Initial) I understand that I am responsible for providing my own scrubs and textbook (approximate cost $150)

(Initial) I understand by initializing I have the right to receive a signed copy of this agreement and the institution is obligated to provide an exact signed copy of this agreement.

The TN Professional Training Institute is authorized by the Tennessee Higher Education Commission. This authorization must be renewed each year and is based on an evaluation of minimum standards concerning quality of education, ethical business practices, and fiscal responsibility.

Admissions Requirements:

Students wishing to enroll in the TN Professional Training Institute's 160 Hour Patient Care Technician Program must meet these admissions criteria:

  • Must be 18 years of age or older, as required by the Tennessee State Board
  • In good standing with no felony convictions. Misdemeanors are not immediate disqualifiers
  • Willing and able to work with patients while giving the best patient care possible.
  • Must be a high school, G.E.D or HiSET graduate and submit OFFICIAL transcripts indicating date of graduation or completion before beginning class. These may be emailed to: info@TNPTI.com or mailed to: TNPTI at 1630 South Church Street, Suite 302 Murfreesboro, TN 37130
Attendance Requirements:

TN Professional Training Institute's Patient Care Technician program is an intensive, accelerated, 160 hour program. Students who miss any class time may be moved to the next session at the discretion of the instructor.

Progress(Grades):

The instructor will keep a daily log of the student's grades and will communicate with students their updated grades on a daily basis. However, students are ultimately in charge of keeping track of their own progress in the class and TNPTI is not responsible for students who forget to check their email, messages, etc.



Signature of Student:

Date:
 
TNPTI Dress Code:
  •  All students must wear black scrubs during classroom hours.
  •  All students must wear closed toe and closed heel shoes during classroom hours.
  •  The students must wear their hair up if hair length is longer than shoulder length.
  •  Acrylic nails are not permitted during classroom hours. Natural nails can be painted in French tip or in a clear color. Colored nail polish other than clear is not permitted.
  •  Lab coats provided by the school should be worn during clinical/lab hours.
  •  PPEs should be worn at all times during clinical hours.


Signature of Student:


Date:

 
Code of Conduct:
 All TNPTI students must abide by the TNPTI Code of Honor

The TN Professional Training Institute is an institution where students can learn in a polite, respectful, and productive environment. We ask that all students hold true to these standards to maintain this level of learning for all.

  •  Be respectful of the property and of each other. Try to arrive 10 minutes early for classes.
  •  All TNPTI students will abide by the TNPTI Code of Honor.
  •  Students are allowed to respectfully consume snacks and drinks during classroom sessions only. Please do not abuse these privileges!
  •  When in a clinical environment, students will refrain from chewing gum, eating, and drinking during this time.
  •  To maintain a professional clinical environment, TNPTI students are asked to code any visible tattoos/body art - additionally, jewelry is restricted to only one (1) piercing (per lobe) per ear and one (1) wedding band/ring if applicable.


Signature of Student:

Date:

 
TNPTI Code of Honor:

Code Defined: It is presumed that any student who enrolls at TN Professional Training Institute is willing to conform to a pattern of mutual trust and honor and shall deal honorably with all members of the TNPTI community. It must be understood that it is the responsibility of each student, faculty, and staff member to preserve, nurture and strengthen this spirit of honor.

TNPTI students shall at all times refrain from and discourage all attempts at lying, cheating, stealing, plagiarism and vandalism. When a violation of the Honor Code is detected, the student(s) involved will be brought to the attention of the instructor and the Institutional Director or the Executive Director, who will come to a mutual agreement upon the disciplinary action appropriate for the action against the TNPTI code of honor.


Violations Defined:

"Lying" is defined as any attempt to deceive, falsify, or misrepresent the truth in any matter involving program business. Program business includes but is not limited to, financial aid information, excuses for absences, statements to professors in order to reschedule tests or assignments and responses to the queries of TNPTI staff.

"Cheating" is defined as the employment of or rendering of any illicit aid in any assigned work.

"Stealing" is defined as the appropriation of money or property belonging to another person, organization, or the school or the borrowing of property without the knowledge of the owner.

"Plagiarism" is defined as presenting as one's own work the words or ideas of an author or fellow student. Students should document quotes through quotation marks and footnotes or other accepted citation methods. Ignorance of these rules concerning plagiarism is not an excuse. When in doubt, students should seek clarification from the instructor who made the assignment.

"Vandalism" is defined as intentional, malicious damage to university property or property belonging to others.

Penalties: The directors may, for any first offense violation of the TNPTI Code of Honor, impose immediate dismissal of the student for the remainder of the program (depending on the severity of the violation). Dismissed students will not receive a refund for tuition monies paid.


Signature of Student:

Date:

 
Graduation Placement Data 2023 - 2024 Reporting Year:
Date:
 
Receipt of Enrollment Contract:

I,, verify that I have reviewed this enrollment contract with a TNPTI staff member, that I understand it in entirety, and I understand that I have received an exact signed copy of this entire enrollment contract.

Enter your name:

Signature of Student:

Date:

 
Photograph & Video Release Form:

I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse commercial settings within an unrestricted geographic area.


Photographic, audio or video recordings may be used for the following purposes:

  • Commercial presentations
  • Online music video platforms(YouTube, Vimeo, etc.)
  • Television or broadcast media distribution


By signing this release, I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the Internet or in the public business settings.

I will be consulted about the use of the photographs or video recording for any purpose other than those listed above.

There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.

This release applies to photographic, audio or video recordings collected as part of the sessions listed on this document only.

By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for entertainment purposes.


Full Name (Print):


Signature of Student:

Date:

 
Effective January 1, 2024

Effective January 1, 2026, TNPTI tuition ($4,600)



 

Signature of Student:

Date: 

 
Refund & Cancellation Policy:

Any student enrolling in a course at TN Professional Training Institute is eligible for a full refund if the student withdraws from TN Professional Training Institute on or before the first day of classes or fails to begin class on the start date as written in the enrollment agreement. The refund shall equal the sum of all amounts paid or to be paid by or on behalf of the student for the period of enrollment, less an administrative fee of one hundred dollars ($100.00). If the student has institutional loans, this will include forgiveness of the amounts owed by the student, less an administrative fee of one hundred dollars ($100.00).

If, after classes have commenced, a student who has enrolled in any TN Professional Training Institute course withdraws, drops out, is expelled, or otherwise fails to attend classes after the first day and until 20% of the course is in session, the refund shall be a pro rata portion of amounts paid, less an administrative fee of one hundred dollars ($100.00). If applicable, the refund shall include forgiveness of institutional loans. For example, if a students last day of attendance equals ten percent (10%) of the enrollment period of enrollment, for which the student was charged, TN Professional Training Institute is only entitled to retain ten percent (10%) of the amount paid as well as an administrative fee of one hundred dollars ($100.00). However, in no instance will TN Professional Training Institute be responsible for any refund in excess of the amount paid by or on behalf of the student.

If, after classes have commenced, a student who has enrolled in any course at TN Professional Training Institute withdraws, drops out, is expelled, or otherwise fails to attend classes after 20% of the course, the student is responsible for one hundred percent (100%) of the tuition, fees and other charges assessed by the TN Professional Training Institute and will not be issued a refund.

A student who at any time withdraws, is withdrawn by the institution, or otherwise fails to attend class is entitled to a full refund of any fee for tangible goods or services not delivered to or fully provided to the student. 

The refund request must be made in writing via email to info@tnpti.com within 10 days of the first day of missed class.

I have read the above policy, and understand the information contained within.


Full Name (Print):

Signature of Student:

Date: