Allied Professional Institute 5199 E Pacific Coast Hwy, Ste 300N Long Beach, CA 90804
Address where instructions will be provided
Address City State Zip Code
B. This agreement is a legally binding instrument when signed by the student and accepted by the school. Your
signature on this agreement acknowledges that you have been given reasonable time to read and understand it and
that you have been given: (a) a written statement of the refund policy including examples of how it applies and ; (b) a
catalog including a description of the courses or educational service including all material facts concerning the school
and the program or course of instruction which are likely to affect your decision to enroll. Immediately upon signing
this agreement, you will be given a copy of it to retain. This enrollment agreement is in force from the first day class
until after enrollment or if the student withdraws from the class or fails academically.
C. This agreement is for the course or education service Basic Phlebotomy Technician .
Title and Description
A total of 40 Hrs lecture are required to complete the course or education service.
Clock hours, weeks, lessons
Start Date: Scheduled Completion Date:
D. STUDENT'S RIGHT TO CANCEL.. The student has a right to cancel this enrollment agreement and obtain a
refund of charges paid through attendance at the first class session, or the seventh day after enrollment, whichever is
later; by this date . The student has a right to withdraw from class at anytime and receive a pro rata
refund of charges paid from attendance on the first day of class to the time of cancellation.
You may cancel this enrollment agreement and receive a refund by providing a written notice to Mildred Casper,
Director, Allied Professional Institute, 5199 E. Pacific Coast Hwy, Ste 300N, Long Beach, CA 90804.
E. REFUND POLICY: The student has a right to a full refund of all charges less the amount of $100.00 for the
registration fee if he/she cancels this agreement prior to or on the first day of instruction or the seventh day after
enrollment, which ever is later. If the student has received federal student financial aid funds, the student is entitled
to a refund of moneys not paid from federal student financial aid program funds. The amount retained for registration
fee may not exceed one hundred dollars ($100).
In addition the student may withdraw from a course after instruction has started and receive a pro rata refund for
the unused portion of the tuition and other refundable charges if the student has completed 60% or less of the
instruction. For example, if the student completes only 30 hours on a 90-hour course and pay $300.00 tuition, the
student would receive a refund of $200.
$300.00 X 60 clock hours of instruction = $200.00
amount paid paid for but not received refund
for instruction 90 clock hours of instruction amount
for which the student has paid
F. Any written contract or agreement signed by a prospective student shall not become operative until the
student attends the first class or session of instruction. This provision does not apply to correspondence schools or
other distance-learning programs.
G. LOANS: if the student obtains a loan to pay for an educational program, the student will have the
responsibility to repay the full amount of the loan plus interest, less the amount of any refund.
If the student is eligible for a loan guaranteed by the federal or state government and the student defaults on the
loan, both of the following may occur.
The federal or state government or a loan guarantee agency may take action against the student, including
applying and income tax refund to which the person is entitled to reduce the balance owed on the loan.
The student may not be eligible for any other federal student financial aid at another institution or other government
assistance until the loan is repaid.
H. "NOTICE CONCERNING TRANSFERABILITY OF CREDITS AND CREDENTIALS EARNED AT OUR
INSTITUTION: The transferability of credits you earn at Allied Professional Institute is at the complete discretion of an
institution to which you may seek to transfer. Acceptance of the Phlebotomy certificate you earn in Phlebotomy
Technician I Program is also at the complete discretion of the institution to which you may seek to transfer if the
Phlebotomy certificate that you earn at this institution are not accepted at the institution to which you seek to transfer,
you may be required to repeat some or all of your course work at the institution. For this reason you should make
certain that your attendance at this institution will meet your educational goals. This may include contacting an
institution to which you may seek to transfer after attending Allied Professional Institute to determine if your
Phlebotomy certificate will transfer."
I. "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, and salaries or wages, and the most recent three-year cohort default rate, if
applicable, prior to signing this agreement."
"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."
J. Any questions a student may have regarding this enrollment agreement that have not been satisfactorily
answered by the institution may be directed to the Bureau for Private Postsecondary Education at 2533 Capitol Oaks
Drive, Ste 400, Sacramento, CA 95833. Mailing address: PO Box 980818, West Sacramento, CA 95798-0816.
Phone number (916)431-6959. Toll free (888)370-7589. Fax (916)263-1897.
K. A student or any member of the public may file a complaint about this institution with the Bureau for Private
Postsecondary Education by calling (888)370-7589 or by completing a complaint form, which can be obtained on the
bureau's internet Website www.bppe.ca.gov.
L. FEES AND CHARGES. The student is responsible for the following fees and charges.
Basic Phlebotomy Tuition 40 hour course
with less than 1040 of on the job
experience $ 1700.00
Registration Fee $ 100.00 Included in tuition
Equipment $ 0 Included in tuition
Lab Supplies and Kits $ 0 Included in tuition
Textbooks $ 0 Included in tuition
Scrubs/Uniforms $ 0 To be provided by student
In-resident Housing $ NA
Tutoring $ NC
Assessment fees for transfer $ NA
Fees for transfer of credits $ NA
Student Tuition Recovery
Fund Fee (Non-refundable) $ 0
Any other institutional charge or fee $ 0
TOTAL CHARGES $ 1700.00
TOTAL CHARGES FOR THE CURRENT PERIOD OF ATTENDANCE: $1700.00 FOR THE BASIC 40 HOUR COURSE
WITH LESS THAN 1040 HOURS OF ON THE JOB EXPERIENCE . ESTIMATED TOTAL CHARGES FOR THE ENTIRE
EDUCATIONAL PROGRAM: $1700.00. AND THE CHARGES THE STUDENT IS OBLIGATED TO PAY UPON
M. I understand that this is a legally binding contract when signed by the student and accepted by the
institution. My signature below certifies that I have read, understood, and agreed to my rights and
responsibilities, and that the institution's cancellation and refund policies have been clearly explained to
N. My signature below certifies that I have read, understood, and agreed to my rights and responsibilities, and
that the institution's cancellation and refund policies have been clearly explained to me.
SIGNATURE OF STUDENT DATE
INSTRUCTOR'S SIGNATURE DATE
O. STUDENT TUITION RECOVERY FUND
"You must pay the state-imposed assessment for the Student Tuition Recovery Fund (STRF) if all of the following
applies to you:
1. You are a student, who is a California resident, or are enrolled in a residency program, and prepay all or part
of your tuition either by cash, guaranteed student loans, or personal loans, and
2. Your total charges are not paid by any third-party payer such as an employer, government program or other
payer unless you have 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:
1. You are not a California resident, or are not enrolled in a residency program, or
2. 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."
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 any of the following:
1. The school closed before the course of instruction was completed.
2. Te school's failure to pay refunds or charges on behalf of a student to a third party for license fees of any
other purpose, or to provide equipment or materials for which a charge was collected within 180 days before the
closure of the school.
3. The school's failure to pay or reimburse proceeds received by the school prior to closure to excess of tuition
an other costs.
4. There was a material failure to comply with the Act or 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 Act."