Please complete legibly using black ink First Name _____________________________________ Last Name __________________________________________________ Street Address __________________________________________________________________________________________ City ______________________________________ Province/State ____________________________________________________ Postal/Zip Code _________________________ Country ____________________________________________________________ Phone _________________________________________ Mobile Phone _______________________________________________ Email Address ________________________________________ Present Occupation _____________________________________ Group/Industry ID _________________________ (for internal use only) Educational History (Minimum entry requirement: High School Diploma, High School Equivalent or Mature Student) __ High School Diploma ___ Mature Student ___ Associate
Degree ___ Undergraduate ___ Post Graduate How did you hear about
Chartered Herbalist Diploma Program Start Date ____________________ (To be entered by student) End Date ____________________ (To be entered by student) To be dated 1 year from Start Date. Program may be completed prior to End Date. FEE SCHEDULE – Canadian Funds
NOTE: ANY MAILING COSTS INCURRED IN SENDING AND RECEIVING BACK OF LESSONS IS THE RESPONSIBILITY OF THE STUDENT.
Payment Information __ I have enclosed a money order/cheque in the amount of $______________________ __ Visa __ MasterCard __ American Express I hereby authorize
Credit Card #
____________________________________________ Expiry Date _____ / _____ Cardholder Name (Please Print) ________________________________________________________________________________ Cardholder Signature ________________________________________________________________________________________ REFUND POLICY 1. Written notice must be provided (a) by a student to
(b) by the College to the student when the College dismisses a student. 2. 0-14 days after start date: Full refund (minus shipping & handling and registration fee) provided that written notice has been received and all program materials have been returned in their original condition. Additional deductions will be made for program materials that are not returned in their original condition. 3. 15-30 days after start date: 50% refund (minus shipping & handling and registration fee) provided that written notice has been received and all program materials have been returned in their original condition. Additional deductions will be made for program materials that are not returned in their original condition. 4. 31+ days after start date: No refund. 5. If a student is dismissed (see Dismissal Policy): No refund. RE-REGISTRATION POLICY Students who are unable to complete the program within the one year duration may re-register for a one year extension. Students must apply for re-registration within their original one year enrollment period. Students receive only one extension for the program. For students who do not complete the program by the end of the one year extension period, their program enrollment will expire and they will have to re-enroll to complete this program at the full program fee. Re-registration does not apply if student enrollment has expired or been terminated. GROUP RATE POLICY Each student within the group will receive the same Start Date and End Date - one year in length. All lessons must be forwarded and the final exam must be written within this one year period. Students registered with a group rate that are unable to complete the program requirements within the designated Start Date and End Date may re-register. No group rate will apply to students who re-register. DISMISSAL POLICY Certain conditions, including but not limited to the following, will bring on discipline whereby students may be suspended or dismissed from the College: excessive unexcused absences; failure to complete assignments and to maintain a passing grade over an extended period of time; conduct that interferes with fellow students, faculty, staff or patients; sexual harassment of fellow students, faculty, staff or patients; untreated chemical dependency; dishonesty in admission application; cheating or plagiarism; practicing as a Chartered Herbalist before graduation unless qualified at another level of Herbal Education and approved at the discretion of the College. Students who have been disciplined may appeal by following the Dispute Resolution Policy. DISPUTE RESOLUTION POLICY The goal of the College is to provide professional training in a setting where the working relationships are co-operative. The administrative staff is available to discuss concerns and to offer assistance. Please report any difficulties you encounter to the Dean immediately. The College has developed the following process for resolving disagreements or disputes among employees, instructors and students: 1. Try to resolve your concerns with the involved individual employee, instructor or student of the College. 2. If your concerns have not been resolved to your satisfaction put them in writing and forward them to the Dean. The Dean will have two weeks to consider the concerns. The Dean will consult all parties to the dispute and may recruit a written opinion from them. The Dean will make recommendations for their resolution in writing to all parties to the dispute. 3. If you are not satisfied with the recommendations of the Dean you may address your concerns in writing to the President of the College. The President will review your appeal and the recommendations of the Dean. The President will provide his/her decision in writing within ten working days of receipt of these reports. 4. In cases where there are still some concerns, the President of the College may engage the services of a mediator/arbitrator. In these cases all parties must agree to accept the mediation process in advance. DISCLOSURE STATEMENTIn accordance with Part 4(10)(1)(a) of the Personal Information Protection Act, we hereby notify you that your name and personal identification information, the name of your program of study, and the amount of the tuition paid will be forwarded to the Private Career Training Institutions Agency for the purpose of administering the Student Training Completion Fund. This information is collected by the PCTIA under section 26 of the Freedom of Information and Protection of Privacy Act. For more information about the collection, use and disclosure of your personal information, visit the Agency's website at www.pctia.bc.ca Diploma will be issued upon
completion of academic and financial requirements to
My signature below certifies that I have read, understood and agreed to my rights and responsibilities, and that the College’s policies outlined above have been clearly explained to me. I hereby apply for registration: Student Signature ____________________________________________________ Date __________________________________ Parent/Guardian Signature (if student is under the age of 19) _______________________________________________________________ Registrar Signature ___________________________________________________ Date __________________________________
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