IV Therapy Daytime 2020-2021
Page 1 of 1
CCC IV Therapy Course Application
MAIDEN NAME (if applicable)
Please enter your address, including city, state and zip code. Thank you.
CELL PHONE NUMBER
Please enter the area code with the phone number.
HOME PHONE NUMBER
Please enter the area code. Type N/A if you don't have a land line home phone. If you use a cell phone for your home phone, please just enter a cell phone number when requested.
Please enter the last four digits of your social security number.
Please enter your date of birth.
You must be 18 prior to graduation from the practical nursing program.
Missouri LPN Nursing License Number:
**License will be verified to be current and unencumbered**
Are you willing to meet the necessary expenses of the course?
Have you ever been convicted of a felony?
A felony conviction will not exclude you from being accepted.
Select at least 0 and no more than 0.
If yes, please describe charge/conviction
IV Therapy program tuition varies by date. The Cass Career Center Institutional Refund Policy is outlined below: Please type in your initials to indicate understanding.
Tuition is 100% refundable up until the first day of class, and after that, the following policy applies: 1. The school will retain 25% of the tuition for students withdrawing in the first week of the payment period. Withdrawal may be voluntary or involuntary. 2. The school will retain 50% of the tuition for students withdrawing in weeks 2, 3, and 4 of the payment period. Withdrawal may be voluntary or involuntary. 3. The school will retain 100% of the tuition for students withdrawing during or after week 5 of the payment period. Withdrawal may by voluntary or involuntary. 4. Student activity fees, club dues, and supplies are nonrefundable.
You will be required to provide a copy of your most recent background check (within the last year). If you cannot provide a background check, we will require one to be completed. The cost is $51.50. Please type your initials to indicate an understanding of the statement.
A criminal background clearance check will be conducted and must be successfully completed as required by state law. Any individual who has been convicted of a felony against persons (as specified in Chapter 660.317, RSMO) may not be admitted into the course.
Cass Career Center is an affirmative action school. No person shall, on the basis of race, sex, creed, color or handicap, be subject to discrimination in employment or in admission to any educational program or activity. Please type your initials to indicate an understanding of the statement.
To the best of my knowledge, all of the information in this application is complete and correct. I authorize investigation of all statements in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Please type your full name (including middle initial) and last four of your SS# to confirm that you acknowledge the information contained in the application is true to the best of your knowledge.
Prior to start of class, evidence of the following vaccinations will need to be submitted to the school: MMR x 2 (30 days apart) Varicella x 2 (30 days apart) Flu shot (for current year) Tdap (within the last 10 years) TB Test (Two step if never have had TB test OR One step and evidence of a previous TB test) Questions? Please contact email@example.com Please inital to acknowledge your understanding.
Please provide an email address. Confirmation of receipt of your application will be emailed to you.
Please contact us via phone or email to set up payment and receive further instructions. We are unable to hold your seat in the class until we receive payment. Contact information: P: (816) 380-3253 ext. 7223 E: firstname.lastname@example.org or email@example.com Please type your initials to indicate your understanding.