2017-2018 - covenant healthcare institute · chapter 18 assisting with urinary elimination chapter...

48
1 COVENANT HEALTHCARE INSTITUTE, INC. 18216 Hardwood Street, Homewood, IL 60430 Web: http://www.covenanthealthcareinstitute.org/ Email: covenanthealthcinstitute.com Tel:312 388 0098 |Fax: 773 233 2917 2017-2018 (August 2017)

Upload: others

Post on 06-Jun-2020

1 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

1

COVENANT HEALTHCARE INSTITUTE, INC.

18216 Hardwood Street, Homewood, IL 60430

Web: http://www.covenanthealthcareinstitute.org/

Email: covenanthealthcinstitute.com

Tel:312 388 0098 |Fax: 773 233 2917

2017-2018

(August 2017)

Page 2: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

2

TABLE OF CONTENTS

Content Page

Certificate of Approval 3

Message from the President 4

About Covenant Healthcare Institute, Inc.

- Our Mission

- Our Vision

- Institutional Objectives

- Approval/Membership

- Legal Control

- Management/Faculty and Staff

- Hours of Operation

- Academic Calendar

-Projected Course Offerings

5-8

Program Description 9-10

Course Content Outline 10

Skills Lab Reference 11

Program Cost 12

Malpractice Insurance 13

Admissions Requirements 14

Program Progression Requirements 16

Theory Grade Requirements 16

Testing Policy 17

Lab Procedures Competency Requirements 18

Use of Lab Facility 19-20

Clinical Rotation Hours 21

Clinical Grade Requirements 22

Clinical Supervision 23

General Conduct Expectations 24-35

OSHA Compliance 36

Non-Discrimination 37

Release of Transcript of Records 38

Statement of Credit Transferability 39

Complaints/Grievance Policy 40

Enrollment Agreement 42-48

Success Data 48

Acknowledgement of Receipt 48

Page 3: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

3

CERTIFICATE OF APPROVAL

Covenant Healthcare Institute, Inc. is approved to operate by the Private Business and Vocational

Schools Division of the Illinois Board of Higher Education.

Permit to Operate

Certificate of Approval to Operate Issued by:

Private Business Vocational School Division

Illinois Board of Higher Education (IBHE)

1 N. Old State Capitol Plaza, Suite 333

Springfield, Illinois 62701

Ph.217-782-2551

Fx.217-782-8545

www.ibhe.org

Program Approval

Illinois Department of Public

Health

Education and Training Section

525 W Jefferson, 4th Floor

Springfield, IL 62761

Tel: 217-524-7237

Page 4: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

4

MESSAGE FROM THE PRESIDENT

Welcome to Covenant Healthcare Institute! We are delighted to have you in our Basic Nursing

Assistant Training Program. We are an organization committed to helping aspiring individuals

like you achieve your personal and career goals by taking you to the process one small step at a

time. Our curriculum covers contents that meet federal and state standards. Our faculty members

are experienced nursing educators with expertise in clinical nursing practice. We have the

training and tools to help you land a beginning career in the healthcare industry. We are here to

support you in any way we can.

Thank you for making us part of your career journey. Feel free to contact our office for any

assistance.

Sincerely,

Bisola Adeniran, BSN, RN

(School Administrator)

Page 5: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

5

ABOUT COVENANT HEALTHCARE INSTITUTE

MISSION

The mission of Covenant Healthcare Institute is to train students become providers of quality,

competent and compassionate health care services.

VISION

Our vision is to become a premier source of knowledgeable, skilled, competent and reliable

nursing assistants to help fill the healthcare facilities’ staffing needs for basic nursing services.

INSTITUTIONAL OBJECTIVES

Covenant Healthcare Institute aims to:

▪ Create and maintain an administrative infrastructure that complies with the federal, state

and local regulations.

▪ To recruit and retain employees with the right academic and work backgrounds to provide

instructions and facilitation of students’ teaching and learning time with us.

▪ Promote and support professional growth and development activities for our faculty and

staff.

▪ Have a curriculum content that covers the theoretical and technical academic needs of the

students.

▪ Have graduates who are able to demonstrate knowledge, skills and competence to

work in any given healthcare setting.

▪ Strive to provide a classroom environment conducive to teaching and learning.

▪ Create partnerships with other constituents to help students achieve economic growth.

APPROVALS/MEMBERSHIP AND ACCREDITATION

▪ Illinois Board of Higher Education (IBHE)

▪ Illinois Department of Public Health (IDPH)

▪ Covenant Healthcare Institute is not accredited by an organization recognized by the U.S

Department of Education as an accrediting body.

LEGAL CONTROL OF THE INSTITUTION

Bisola Adeniran, BSN, RN

(School Administrator)

Page 6: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

6

MANAGEMENT|FACULTY|STAFF

Bisola Adeniran, BSN, RN-School Administrator/Program Coordinator

Taiwo Adeniran, RN, BSN-Business Manager

Page 7: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

7

HOURS OF OPERATION

Classroom 9:00AM to 9:00PM, Monday-Sunday

Student Services 9:00AM to 5:00PM, Monday-Friday

Business Services 9:00AM to 5:00PM, Monday-Friday

Skills Lab 9:00AM to 9:00PM, Monday-Sunday

Computer Lab 9:00AM to 9:00PM, Monday-Sunday

Page 8: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

8

ACADEMIC CALENDAR

2017

Wednesday, January 2 New Year’s Day

Monday, January 16 Birthday of Martin Luther King, Jr.

Tuesday, May 30 Memorial Day

Tuesday, July 4 Independence Day

Monday, September 4 Labor Day

Thursday, November 23 Thanksgiving Day

Monday, December 25 Christmas Day

2018

Monday, January 1 New Year’s Day

Monday, January 15 Birthday of Martin Luther King, Jr.

Monday, May 28 Memorial Day

Wednesday, July 4 Independence Day

Monday, September 3 Labor Day

Thursday, November 23 Thanksgiving Day

Tuesday, December 25 Christmas Day

PROJECTED COURSE OFFERINGS

2017

1ST Term

2nd Term

3rd Term

4th Term

October2-December 22

BNATP

2018

1ST Term

Jan1-Mar23

2nd Term

April7--June 27

3rd Term

July2-September

21

4th Term

October1-December 21

BNATP BNATP BNATP BNATP

Page 9: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

9

PROGRAM DESCRIPTION BASIC NURSING ASSISTANT TRAINING (CIP Code 51.3902)

A program that prepares individuals to perform routine nursing-related services to patients in hospitals or long-term

care facilities, under the training and supervision of a registered nurse or licensed practical nurse

(https://nces.ed.gov/ipeds/cipcode/cipdetail.aspx?y=55&cipid=88827).

Description: Clock Hours: 120 (Theory|Lab|Clinical: 60|20|40)

This 120 clock-hour program meets the requirements of Illinois Nursing Reform Act of 1979. Completion of the

program leads to certification of compliance from the Illinois Department of Public Health (IDPH). This program

prepares students into their roles and responsibilities as nurse assistants in both the clinical and at home setting. The

course includes a coordinated lecture/discussions, supervised skills laboratory and clinical practice. Students acquire

the basic knowledge and technical skills needed to provide basic nursing care to residents in long-term care facilities

as well as patients in hospitals, private homes, or other health care facilities. Upon successful completion of this

program, students are eligible to sit for the Illinois Nurse Aide Competency Examination administered by Southern

Illinois University of Carbondale.

Certification Requirement:

To be able to work in long term care facilities, successful graduates must pass the competency exam given by the

SIUC within 120 days from program completion.

Student Learning Objectives/Expected Outcomes:

At the end of the course, the student will be able to:

▪ Describe the healthcare system and its role as part of the nursing team

▪ Describe the person’s rights

▪ Describe the role of the nursing assistant

▪ Identify good work Ethics

▪ Learn how to communicate with the healthcare team

▪ Have a better understanding of the person

▪ Describe the human body structure and function

▪ Discuss and demonstrate how to provide care for the older adults

▪ Discuss and demonstrate how to promote safety

▪ Discuss and demonstrate how to prevent falls

▪ Demonstrate the use of restraints alternatives and safe restraint use

▪ Discuss and demonstrate how to prevent infection

▪ Discuss and demonstrate benefits of good body mechanics

▪ Discuss and demonstrate how to safely handle, move and transfer the person

▪ Discuss and demonstrate how to perform grooming and hygiene

▪ Demonstrate how to assist residents with their nutritional needs

▪ Discuss and demonstrate how to assist residents with bowel and urine elimination

▪ Discuss and demonstrate how to collect specimen

▪ Discuss and demonstrate how to assist with exercise and activity

▪ Discuss and demonstrate how to assist with wound care

▪ Discuss and demonstrate how to assist with oxygen needs

▪ Discuss and demonstrate how to assist with rehabilitation and restorative nursing care

▪ Discuss and demonstrate how to care for person with common health problems

▪ Discuss and demonstrate how to care for person with mental health problems

▪ Discuss and demonstrate how to care for person with confusion and dementia

▪ Discuss and demonstrate how to assist with emergency care

▪ Discuss and demonstrate how to care for the dying person

Page 10: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

10

COURSE CONTENT OUTLINE

CONTENT OUTLINE/REQUIRED READINGS SKILLS LAB CLINICAL

WEEK 1

Chapter 1 Hospitals and Nursing Centers

Chapter 2 The Person’s Rights

Chapter 3 The Nursing Assistant

Chapter 4 Work Ethics

Chapter 5 Communicating with the Health Team

Chapter 6 Understanding the Person

WEEK 2

Chapter 7 Body Structure and Function # 1, 2, 3, 4, 5, 13, 21

Chapter 8 Care of the Older Person

Chapter 9 Assisting with Safety

Chapter 10 Assisting with Fall Prevention

Chapter 11 Restraint Alternatives and Safe Restrain Use

Chapter 13 Body Mechanics

Chapter 14 Assisting with Moving and Transfer

WEEK 3

Chapter 12 Preventing Infection # 6, 7, 8, 9,

10,11,15,17,19

Chapter 15 Assisting with Comfort

Chapter 16 Assisting with Hygiene

Chapter 17 Assisting with Grooming

Chapter 18 Assisting with Urinary Elimination

Chapter 19 Assisting with Bowel Elimination

Chapter 20 Assisting with Nutrition and Fluids

WEEK 4

Chapter 21 Assisting with Assessment #12, 14, 16, 18, 19, 20

Chapter 22 Assisting with Specimens

Chapter 23 Assisting with Exercise and Activities

Chapter 24 Assisting with Wound Care

Chapter 25 Assisting with Pressure Ulcers

Chapter 26 Assisting with Rehabilitation and Restorative

Nursing

WEEK 5

Chapter 27 Assisting with Oxygen Needs Skills Validation

Chapter 28 Caring for Persons with Common Health Problems

Chapter 29 Caring for Person with Mental Health Disorders

Chapter 30 Caring for Person with Confusion and Dementia

Chapter 31 Assisting with Emergency Care

Chapter 32 Assisting with End of Life Care

WEEK 6

Clinical # 1

Clinical # 2

Clinical # 3

Clinical # 4

Clinical Clinical Evaluation # 5|

Theory 60 hours|Lab 20 hours|Clinical 40 hours

Page 11: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

11

SKILLS LAB REFERENCE

The following skills procedures are taught during skills lab portion of the program.

Students are expected to be able to perform the following minimum required 21 skills:

1. Wash hands 2. Oral hygiene

3. Hair care 4. Shaving resident

5. Nail care 6. Take temperature

7. Take pulse 8. Respiration

9. Blood pressure 10. Make unoccupied bed

11.

12. Make occupied bed 13. Feed resident

14. Dress resident 15. Unit check

16. Measure weight 17. Measure height

18. Place resident in side-lying position 19. Passive range motion

20. Calculate intake/output 21. Transfer resident to wheelchair

22. Partial bath Other skills:

Care of hearing aids

Care of eyeglasses

Care of dentures

Page 12: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

12

PROGRAM COST

TUITION & FEES

Program Cost Full Assessment:

Tuition Fee 750.00

Laboratory Fee 50

Registration Fee 75.00

Technology Fee 50.00

Book|Study Guide 100.00

Uniform 25.00

Materials & Equipment** (Gait belt, watch w/ second hand, stethoscope, sphygmomanometer)

25.00

Certification Exam Fee (SIUC) 65.00

Criminal Background Check

60.00 CPR Certification 50.00

Malpractice Insurance 25.00

TOTAL AMOUNT DUE

$1,250.00

Page 13: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

13

MALPRACTICE INSURANCE

Each student enrolled is required to carry malpractice insurance. The cost for this insurance is

added to the course fees and is paid automatically at the time of tuition payment by the student.

THE COST OF THE INSURANCE IS NOT REFUNDABLE.

Page 14: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

14

ADMISSION REQUIREMENTS

1. Must be at least 16 years of age

2. Must demonstrate basic proficiency knowledge of English, Math and Science at the 10th grade

3. A Physical examination by a licensed physician, which includes a TB test and immunization

status. This is required before a student can start clinical rotation.

4. A Criminal Background Check with the IL State Police at the beginning of the training in

compliance with the Health Care Worker Background Check Act.

5. Proof of Medical Health Insurance coverage

6. Current CPR Card

Page 15: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

15

PROGRAM PROGRESSION REQUIREMENTS

To remain in satisfactory academic standing, a student must meet the theory, lab, skills and

clinical attendance, grade and conduct requirements and meet financial responsibilities as agreed

upon the start of enrollment.

Page 16: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

16

THEORY GRADE REQUIREMENTS

A grade of 75% in daily quizzes, mid-term, final and comprehensive exams must be achieved to

pass the course. The instructor may give quizzes at any time without prior notice. There is no

make-up on missed quizzes; however, at the discretion of the Instructor, a student may be allowed

to make up the midterm, final and comprehensive exams under certain terms and conditions.

Additional teaching and learning time may be required to ensure competency and readiness for the

state exam.

Remediation Plan:

Students who are not able to maintain the required standards, maybe required one or all of the

following initiatives to pass the course:

1. Meet with the designated faculty for tutorial or additional course work.

2. Complete additional practice tests.

3. Retake the exam to bring it to a passing score.

Page 17: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

17

TESTING POLICY

Examinations

To help students prepare for the state competency exam, quizzes, midterm, final and

comprehensive exams will be administered. In addition, students will need to demonstrate

proficiency in all skills procedures and pass the clinical portion of the course. Students are

required to meet the minimum standards of academic progress to remain in the program.

Cheating or act of cheating or an attempt to cheat will not be tolerated. Any student caught in

cheating or an attempt to cheat will be referred to the School Administrator for disciplinary

action, which may include verbal warning, suspension or dismissal from the program.

Individual exam reviews will be granted upon student’s request up to one week after the exam.

Any student who misses a scheduled exam will be allowed to take a makeup exam under the

following conditions:

A. The Instructor must be notified of the absence before the scheduled exam

date/time.

B. The student must reschedule the exam with the instructor of the course within one

week following the exam.

C. Permission will be given only for legitimate excuses, and only when notification of

absence was made.

D. Any student who does not arrange for a make-up exam within one week of

returning to class will automatically receives a grade of (0) zero for the exam.

Page 18: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

18

LAB PROCEDURES COMPETENCY REQUIREMENTS

Skills demonstration and practice are integrated in the program. Students are taught the 21

required skills by IDPH with other skills necessary to provide basic healthcare services.

There is time allotted for skills practice. Students need to demonstrate competency of skills

learned in the classroom.

Lab evaluation is graded as satisfactory, unsatisfactory or needs practice. Students are expected

to be able to demonstrate satisfactorily on campus the 21 skills before he or she will be allowed to

perform these skills in the clinical setting.

Skills validation is done before the students go to clinical and at the end of the program. Any

student who fails to demonstrate successfully on the first attempt will be given a Remediation slip

and will be asked to remediate before a retest maybe given. There are two additional chances to

demonstrate competency. Failure to demonstrate competency on the third attempt may be required

additional learning activities or maybe precluded from the program.

Page 19: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

19

USE OF LAB FACILITY

To ensure safety, the following rules must be observed by all students:

1. Use of Skills Lab:

All students must be under the direct supervision of a qualified Covenant Healthcare

Institute instructor.

2. Personal Belongings

Coat and student belongings are not to be placed on top of the beds or in the sink area. Coats

are to be kept with the student or hung on the coat racks on the wall of the lab. Other student

belongings are to be kept with the student or left at the student's desk/table area.

3. Smoking is not allowed inside the building.

4. Desk/Table Area:

All desks, tables and chairs must be returned to the original location after use.

5. Spills or Wet Areas:

All spills or noted wet areas should be wiped up as soon as possible to prevent slippery

surfaces. Please notify the management if you notice spills on the floor to avoid injuries.

6. Sharp Tools or Razors:

All simulated practice razors are to be covered with the appropriate cover. Razors are to be

discarded in the designated red sharps containers and not in other lab trash containers.

If you are cut with a razor or your skin comes in contact with contaminated material, notify

your supervising instructor immediately and they will be able to assist you with treatment.

7. Waste Materials:

Discard all waste materials in the appropriate designated trash containers. Check under lab

beds and other floor areas for possible waste and discard appropriately before leaving the lab

area.

Page 20: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

20

8. Linens:

Return all un-used linens to the linen cabinet. Place all used/soiled linens in the appropriate

laundry bags. Do not re-use linens that have been previously discarded in the laundry bags.

9. Lab Equipment and Supplies:

Return all equipment to the appropriate designated storage location. Notify lab supervisors of

any malfunctioning equipment as soon as problems are noted. Check all electrical cords for

fraying or loose plugs before inserting into sockets.

10. Student Valuables:

Covenant Healthcare Institute and staff members are not responsible for purses or other

valuables left in the lab. It is highly suggested that all valuables not be brought into the lab

area while students are practicing lab skills.

Page 21: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

21

CLINICAL ROTATION HOURS

Students are required to spend at least 40 hours in the clinical to have the opportunity to apply

their knowledge into practice. The clinical hours will typically follow the following activities:

Clinical

Experience Day Shift

6:00 am -

7:00 am

Pre-conference and patient care planning

7:00 am -

1:30 pm

Students are in the clinical unit area under the supervision of the assigned

Instructor.

1:30 pm -

2:30 pm

Post conference—discussions of clinical cases and integration of theory into the

clinical practice

Clinical

Experience Afternoon Shift

2:00 pm -

3:00 pm

Pre-conference and patient care planning

3:30 pm -

9:00 pm

Students are in the clinical unit area under the supervision of the assigned

Instructor.

9:30 pm –

10:30pm

Post-conference as above

Student / Instructor Ratio 8:1

NOTE: Clinical groups will be announced just prior to the beginning of the scheduled clinical

rotation. Punctuality is absolutely mandatory. All procedures per School Catalog/Student

Handbook must be followed.

Page 22: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

22

CLINICAL GRADE REQUIREMENTS

The following guidelines are used for clinical evaluation: Each student will be evaluated on a

“Satisfactory, Unsatisfactory or Needs Improvement basis. Students with Needs Improvement

have failed the clinical portion.

SATISFACTORY: Student consistently meets the criteria established for effective clinical

performance.

NEEDS IMPROVEMENT (DID NOT PASS): Student inconsistently meets the criteria

established for effective clinical performance.

UNSATISFACTORY: Student consistently fails to meet the criteria established for effective

clinical performance.

Students are evaluated and provided feedback throughout the clinical experience. Each student

will have a post conference with their instructor at the completion of the program to discuss

clinical performance and receive a written evaluation.

Any student having difficulty meeting the standards will have a weekly conference with the

instructor so that appropriate assistance can be provided and minimum competency can be

achieved.

Students will have the chance to complete a self-evaluation during the clinical experience and be

able to review this with their instructors.

Students receiving a “NEEDS IMPROVEMENT” or “DID NOT PASS” rating during a clinical

will discuss their performance with the instructor, and the written evaluation will include a

specific plan for improvement when appropriate.

Needs improvement ratings which have not been brought to the level of satisfactory by the end of

the clinical experience will be termed “UNSATISFACTORY”.

"DID NOT PASS" rating in one or more areas at the end of the clinical will result in an

Unsatisfactory rating in clinical performance for the course. The student will not be eligible for

application to sit for the SIUC Competency Exam.

Upon completion, the original written evaluation will be submitted to the program office and

compiled into the student’s file. Also, one copy of the evaluation will be given to the student.

Page 23: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

23

CLINICAL SUPERVISION

1. Direct one-to-one observation of student skill performance, as when a skill is being done for

the first time with a client and the safety of the client can only be assured by direct observation

and assistance as needed.

2. With guidance a student is completing the skill independently when both student and

instructor feel assured that it will be completed safely.

3. Spot observation of student skill performance at any time during the procedure, as when safe

performance can be expected without continuous observation.

4. Student skill performance without direct observation, to be carried out when the student’s

ability to do so safely is a reasonable expectation applied to all students.

The specific method of supervision used at any time is determined by the instructor with

consideration of the following variables:

1. Assured safety for the client.

2. Previously observed safe performance of a skill in the simulated lab and/or clinical area.

3. Needs for varying degrees of continued observation per strengths and weaknesses identified

by both instructor and the student.

4. Students are encouraged at all times to identify, evaluate and discuss with instructor their

strengths and weaknesses in clinical skill performance and their needs for specific learning

opportunities. They should be thorough in their written self-evaluation at the end of the

clinical experience.

Page 24: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

24

GENERAL EXPECTATIONS

Students must promote a learning environment that facilitates teaching and learning inside and

outside of the institution. All persons shall obey the rules, policies and regulations of Covenant

Healthcare Institute during the initial admission process. Violation of any of the rules and

regulations may result to probation, suspension, or dismissal from the program:

• Dishonesty such as cheating, plagiarism, deliberately providing false information

• Forging, deliberately altering, deliberately misusing official Covenant Healthcare

Institute documents;

• Theft or deliberate damaging of Covenant Healthcare Institute or student property while

on site;

• Endangering the health or safety of Covenant Healthcare Institute personnel or

Covenant Healthcare Institute students on site;

• Using or threatening to use physical force;

• Unauthorized presence on or use of Covenant Healthcare Institute property;

• Theft or deliberate damaging of Covenant Healthcare Institute or student property while

on site;

• Verbal abuse;

• Intent to engage in any willful act that tends to harass, frighten, degrade, or disgrace any

person;

• Obstruction or disruption of classes;

• Discriminatory behavior which run counter to the Covenant Healthcare Institute equal

opportunity for all students;

• Failure to follow the Center directives given by Center personnel;

Page 25: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

25

USE OF ALCOHOL OR ILLEGAL POSSESSION OF SUBSTANCES

Covenant Healthcare Institute strictly prohibits the possession and consumption and/or use of

any illegal or controlled substances or any alcoholic beverage around its premises. In occurrence

of such case, the student may be forced to leave Covenant Healthcare Institute premises. If

applicable, student eligibility of any federal and state financial aid will be terminated upon any

drug conviction.

Page 26: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

26

POSSESSION OF FIREARMS

A student is restricted to carry any firearm(s) to Covenant Healthcare Institute or to a Center

sponsored activity. Further, the student shall not possess, transmit, use, or conceal any firearm(s)

while at the Center or while at a Center sponsored activity.

“Firearms” mean any weapon (including a starter gun) which will or is designed to or may readily

be converted to expel a projectile by the action of an explosive; the frame or receiver of any such

weapon; any firearm, muffler or firearm silencer; or any destructive device.

“Destructive Device” means any explosive; incendiary or poisonous gas; bomb; grenade; rocket

having a propellant charge of more than four ounces; or devices similar to any of such devices.

Page 27: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

27

POSSESSION OF KNIFE OR SHARP OBJECTS

A student is prohibited to bring a knife onto Center property or to a Center sponsored activity.

Further, the student shall not possess, transmit, use, or conceal a knife while at Center or while at

a Center sponsored activity. A knife includes, but is not limited to, any instrument having a sharp

blade and a handle.

Page 28: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

28

LOST OR DAMAGED PROPERTY

Covenant Healthcare Institute and the entire staff hold no responsibility for loss or damaged

personal property. However, such case, if any must be reported to the School Administrator

immediately.

Page 29: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

29

SEXUAL HARRASSMENT

Covenant Healthcare Institute strictly prohibits any act of sexual harassment, either verbal or

physical. If you feel being harassed or assaulted, promptly bring the matter to the immediate

attention of the Instructor or School Administrator.

Page 30: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

30

PERSONAL PHONE CALLS OR MESSAGES

Personal messages will not be taken. The students’ personal phone calls are prohibited during the

course of the training except for emergency cases, a message may be left with the program

secretary. The message will be given to the Instructor for quick delivery to the student. Students

are discouraged to bring cellular telephones to class or clinical lab. If inevitable, cellular phones,

beepers, and other communication devices must be set on “Silent” mode. Incoming and/or

outgoing calls should be done before or after class hours or during breaks to prevent undue

disruption of the training session.

Page 31: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

31

SMOKING

Smoking is strictly prohibited inside the school premises.

Page 32: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

32

PARKING

Smoking is strictly prohibited inside the school premises.

Page 33: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

33

PARKING

Please park in the designated parking areas. Violation of parking rules may lead to towing of your

car at your own expense.

Page 34: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

34

EATING AND DRINKING INSIDE THE CLASSROOM

Eating and drinking in classrooms, hallway, the classrooms or clinical floors is not allowed. All

food is to be consumed in the cafeteria, other designated student lounges or non-instructional

areas.

Page 35: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

35

USE OF SCHOOL ID

Students are required to wear Covenant Healthcare Institute ID badges at all times. If the

student forgets his/her ID badge, he/she must sign in and out with security and report immediately

to the School Administrator for issuance of a temporary ID.

ID badges must be turned in to the nursing department when the student decides to leave the

nursing program or is recommended for separation from the program for any reason.

Page 36: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

36

OSHA COMPLIANCE

All entering nursing students are required to complete an instructional program and associated

posttest for OSHA Regulations and Guidelines related to blood borne pathogens and tuberculosis.

During the first four weeks of entering the semester, students must view the following videos:

Universal Precautions, HIPPA. Students are required to submit signed, complete a posttest based

on these video courses.

Page 37: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

37

NON-DISCRIMINATION POLICY

Covenant Healthcare Institute does not discriminate on the basis of race, color, creed, religion,

national origin, disability, age, marital status, veteran’s status, sex or sexual orientation in admission

to and participation in its educational programs, Center activities and services, or its employment

practices. Inquiries regarding compliance with non-discrimination policies and regulations should be

directed to the School Administrator.

Page 38: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

38

RELEASE OF TRANSCRIPT POLICY

Students may obtain a copy of their transcripts from the Student Services department and file the

request accordingly. The first copy of Transcript of Records is provided free of charge.

Additional copies are charged at $20.00 per transcript for regular processing which generally takes

3-5 business days. There is an additional $10.00 fee for each expedited transcript request that will

take 1 – 2 business days. The student is required to provide his/her signature authorizing release of

his/her transcript. Transcripts may be ordered in person at the corporate office or by mail with a

signed letter of request including payment by credit card or check payable to Covenant

Healthcare Institute. Requests without payments will not be processed.

The student has an option to pick up or mail the Transcript of Records with proper authorization

by the student. Third party requests must be accompanied by written authorization, signed by the

student.

Page 39: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

39

STATEMENT OF CREDIT OR CERTIFICATE OF TRANSFERABILITY

The school does not guarantee the transferability of credits to another school, college, or

university. Credits or coursework are not likely to transfer; any decision on the comparability,

appropriateness and applicability of credit and whether credit should be accepted is the decision of

the receiving institution.

Page 40: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

40

COMPLAINTS/GRIEVANCES PROCESS

At times, students may be unhappy or unsatisfied with the instructor or services. Covenant

Healthcare Institute has an open door policy for student interactions and aims to resolve student

complaints promptly and fairly and does not subject a student to punitive action because written

grievances have been filed with the Center or the Program Administrator.

Any student of Covenant Healthcare Institute who believes he/she has been aggrieved by a

violation shall have the right to file a written complaint within thirty days (10) of the alleged

violation.

The following process should be followed:

1. Submit the written grievance to the School Administrator or Assistant Director of

Nursing

2. The School Administrator shall provide written acknowledge to the grievant within

10 working days’ receipt of such complaint.

3. The School Administrator or Assistant Director of Nursing shall notify and submit

in writing a copy of the grievance to the School Administrator and/or any

significant administrative personnel.

4. The School Administrator shall issue a written finding as to whether there is a need

to proceed to the grievance process or resolution of the concern has occurred.

5. A meeting will be scheduled with the grievant and the School Administrator.

6. The outcome of the meeting/hearing will be forwarded in writing to the grievant

within 10 working days.

7. The action of resolve will be implemented.

8. Covenant Healthcare Institute maintains a written record of all student

complaints as well as the resolution to the issues.

Any student who has been notified of their separation from the Center has the right to appeal their

separation. To appeal, the student must follow the proper lines of communication beginning with

the Instructor and the Program Administrator. Unresolved complaints maybe directed to:

Private Business Vocational School Division

Illinois Board of Higher Education (IBHE)

1 N. Old State Capitol Plaza, Suite 333

Springfield, Illinois 62701

Ph.217-782-2551/Fx.217-782-8545

www.complaints.ibhe.org

Page 41: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

41

RECEIPT OF INFORMATION

Please refer to the back of Enrollment Agreement.

Page 42: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

42

COVENANT HEALTHCARE INSTITUTE, INC.

18216 Hardwood Street, Homewood, IL 60430

Web: http://www.covenanthealthcareinstitute.org/

Email: covenanthealthcinstitute.com

Tel:312 388 0098 |Fax: 773 233 2917

ENROLLMENT AGREEMENT

(Based on IBHE Model)

STUDENT INFORMATION

STUDENT NAME: _______________________________________________________

ADDRESS: _____________________________________________________________

CITY/STATE/ZIP: _______________________________________________________

PHONE NUMBERS: H) _______________ C) _______________ W) _______________

E-MAIL ADDRESS: ______________________________________________________

SOCIAL SECURITY #: _______________________________ STUDENT ID #: _______________

EMERGENCY CONTACT: _________________________________________________

RELATIONSHIP: _____________________________________ TELEPHONE #: _______________

PROGRAM INFORMATION

DATE OF ADMISSION: _____/_____/_____

PROGRAM / COURSE NAME: Basic Nursing Assistant Training Program (CIP Code 51.3902)

DESCRIPTION OF PROGRAM / COURSE: BASIC NURSING ASSISTANT TRAINING (CIP Code 51.3902)

A program that prepares individuals to perform routine nursing-related services to patients in hospitals or long-term

care facilities, under the training and supervision of a registered nurse or licensed practical nurse

(https://nces.ed.gov/ipeds/cipcode/cipdetail.aspx?y=55&cipid=88827).

Description: Clock Hours: 120 (Theory|Lab|Clinical: 60|20|40)

This 120 clock-hour program meets the requirements of Illinois Nursing Reform Act of 1979. Completion of the

program leads to certification of compliance from the Illinois Department of Public Health (IDPH). This program

prepares students into their roles and responsibilities as nurse assistants in both the clinical and at home setting. The

course includes a coordinated lecture/discussions, supervised skills laboratory and clinical practice. Students acquire

the basic knowledge and technical skills needed to provide basic nursing care to residents in long-term care facilities

as well as patients in hospitals, private homes, or other health care facilities. Upon successful completion of this

program, students are eligible to sit for the Illinois Nurse Aide Competency Examination administered by Southern

Page 43: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

43

Illinois University of Carbondale.

________________________________________________________________________________

PREREQUISITE COURSES & OTHER REQUIREMENTS FOR ADMISSION TO PROGRAM /

COURSE:

None

_________________________________________________________________________________

PROGRAM / COURSE OBJECTIVES: Student Learning Objectives/Expected Outcomes:

At the end of the course, the student will be able to:

▪ Describe the healthcare system and its role as part of the nursing team

▪ Describe the person’s rights

▪ Describe the role of the nursing assistant

▪ Identify good work Ethics

▪ Learn how to communicate with the healthcare team

▪ Have a better understanding of the person

▪ Describe the human body structure and function

▪ Discuss and demonstrate how to provide care for the older adults

▪ Discuss and demonstrate how to promote safety

▪ Discuss and demonstrate how to prevent falls

▪ Demonstrate the use of restraints alternatives and safe restraint use

▪ Discuss and demonstrate how to prevent infection

▪ Discuss and demonstrate benefits of good body mechanics

▪ Discuss and demonstrate how to safely handle, move and transfer the person

▪ Discuss and demonstrate how to perform grooming and hygiene

▪ Demonstrate how to assist residents with their nutritional needs

▪ Discuss and demonstrate how to assist residents with bowel and urine elimination

▪ Discuss and demonstrate how to collect specimen

▪ Discuss and demonstrate how to assist with exercise and activity

▪ Discuss and demonstrate how to assist with wound care

▪ Discuss and demonstrate how to assist with oxygen needs

▪ Discuss and demonstrate how to assist with rehabilitation and restorative nursing care

▪ Discuss and demonstrate how to care for person with common health problems

▪ Discuss and demonstrate how to care for person with mental health problems

▪ Discuss and demonstrate how to care for person with confusion and dementia

▪ Discuss and demonstrate how to assist with emergency care

▪ Discuss and demonstrate how to care for the dying person

PROGRAM START DATE: ____________ SCHEDULED END DATE: ____________

FULL-TIME PART-TIME DAY EVENING

DAYS/EVENINGS CLASS MEETS: (circle) M T W Th F Sa Su

TIME CLASS BEGINS: __________ TIME CLASS ENDS: __________

NUMBER OF WEEKS: __________ TOTAL CREDIT or CLOCK HOURS: __________

Page 44: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

44

CONSUMER INFORMATION

• The number of students who were admitted in the program as of July 1 of that reporting

period.

0

• The number of additional students who were admitted in the program during the next 12

months and classified in one of the following categories: new starts, re-enrollments, and

transfers into the program from other programs at the school.

0

• The total number of students admitted in the program during the 12-month reporting

period.

0

• The number of students enrolled in the program during the 12-month reporting period

who: transferred out of the program and into another program at the school, completed or

graduated from a program, withdrew from the school, and are still enrolled.

0

• The number of students enrolled in the program who were: placed in their field of study,

placed in a related field, placed out of the field, not available for placement due to

personal reasons, and not employed.

0

• The number of students who took a State licensing exam or professional certification

exam, if any, during the reporting period, as well as the number who passed.

0

• The number of graduates who obtained employment in the field who did not use the

school’s placement assistance during the reporting period (pending reasonable efforts to

obtain this information from graduates).

0

• The average starting salary for all school graduates employed during the reporting period

(pending reasonable efforts to obtain this information from graduates).

0

FINANCIAL AID EMPLOYER TUITION ASSISTANCE Students who are receiving assistance from employers may have the following financial arrangements:

1. Direct Billing –

Invoice will be billed to employers.

A letter from an employer is required authorizing this arrangement.

Payment will be sent directly to Covenant Healthcare Institute.

2. Reimbursement –

Student will be billed directly and may submit invoice to the employer after successful completion from the

program.

It is assumed that students are responsible for any portion of the educational expenses and fees that are not paid by the

employers.

Page 45: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

45

PROGRAM COST

TUITION & FEES

Program Cost Full Assessment:

Tuition Fee 750.00

Laboratory Fee 50

Registration Fee 75.00

Technology Fee 50.00

Book|Study Guide 100.00

Uniform 25.00

Materials & Equipment** (Gait belt, watch w/ second hand, stethoscope, sphygmomanometer)

25.00

Certification Exam Fee (SIUC) 65.00

Criminal Background Check

60.00 CPR Certification 50.00

Malpractice Insurance 38.00

TOTAL AMOUNT DUE

$1,263.00

REFUND / CANCELLATION POLICY

• Tuition Refund Policy

The following items are refundable:

Unmarked books, unopened lab kit and unused clinical uniform (Price tag must still be in

place).

Lab and clinical fees;

Liability insurance;

The following are non-refundable:

Technology fee

ID Badge

You have the right to pay in full and may obtain refund based on the refund policy.

Any student applying for a program that has been discontinued by the school shall receive

a complete refund of all fees and/or tuition fees paid prorated according to schedule of

refund.

Page 46: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

46

o Tuition Reimbursement Schedule

% of Hours

Attended

Institution Refund

Policy

0-10% 90%

11-20% 80%

21-30% 70%

31% ---- 0%

• Cancellation Policy

The student has the right to cancel the initial enrollment agreement until midnight of the

fifth business day after the student has been admitted. If the right to cancel is not given to

any prospective student at the time the agreement is signed, then the student has the right

to cancel the agreement at any time and receive a refund on all monies paid to date with 10

days of cancellation. Cancellation should be submitted to the authorized official of the

school in writing.

• Withdrawal Procedure

Students wishing to withdraw from the program must do the following to receive a refund:

1. Notify the School Administrator in writing of the intent to withdraw.

2. . Covenant Healthcare Institute, Inc. shall provide written acknowledgment of a

student’s notification of withdrawal within ten (10) calendar days of the postmark

date of the notification of withdrawal. In all instances, refunds shall be based on

and computed from the last day of attendance.

3. If no notification of withdrawal is received, and a student has had an unexplained

absence of more than ten (10) consecutive class days, Covenant Healthcare Institute,

Inc. shall consider the student to have withdrawn from the program. In all cases, the

date of withdrawal shall be the last day of attendance.

4. Refunds shall be made within 30 days of the last day of the attendance.

NOTICE TO STUDENT

1. Do not sign this agreement before you have read it or if it contains any blank spaces.

2. This agreement is a legally binding instrument and is only binding when the agreement is

accepted, signed, and dated by the authorized official of the school or the admissions officer at

the school’s principal place of business. Read all pages of this contract before signing.

3. You are entitled to an exact copy of the agreement and any disclosure pages you sign.

4. This agreement and the school catalog constitute the entire agreement between the student and

the school.

5. Any changes in this agreement must be made in writing and shall not be binding on either the

student or the school unless such changes have been approved in writing by the authorized

Page 47: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

47

official of the school and by the student or the student’s parent or guardian. All terms and

conditions of the agreement are not subject to amendment or modification by oral agreement.

6. The school does not guarantee the transferability of credits to another school, college, or

university. Credits or coursework are not likely to transfer; any decision on the comparability,

appropriateness and applicability of credit and whether credit should be accepted is the

decision of the receiving institution.

STUDENT ACKNOWLEDGMENTS

1. I hereby acknowledge receipt of the school’s catalog, which contains information describing

programs offered, and equipment or supplies provided. The school catalog is included as part

of this enrollment agreement and I acknowledge that I have received a copy of this catalog.

Student Initials ______

2. I have carefully read and received an exact copy of this enrollment agreement.

Student Initials ______

3. I understand that the school may terminate my enrollment if I fail to comply with attendance,

academic, and financial requirements or if I fail to abide by established standards of conduct,

as outlined in the school catalog. While enrolled in the school, I understand that I must

maintain satisfactory academic progress as described in the school catalog and that my

financial obligation to the school must be paid in full before a certificate or credential may be

awarded.

Student Initials ______

4. I hereby acknowledge that the school has made available to me all required disclosure

information listed under the Consumer Information section of this Enrollment Agreement.

Student Initials ______

5. I understand that the school does not guarantee transferability of credit and that in most cases,

credits or coursework are not likely to transfer to another institution. In cases where

transferability is guaranteed, [school name] must provide me copies of transfer agreements

that name the exact institution(s) and include agreement details and limitations.

Student Initials ______

6. I understand that the school does not guarantee job placement to graduates upon program

completion.

Student Initials ______

7. I understand that complaints, which cannot be resolved by direct negotiation with the school in

accordance to its written grievance policy, may be filed with the:

1 N. Old State Capitol Plaza, Suite 333, Springfield, Illinois 62701 or at www.ibhe.org.

Student Initials _____

Page 48: 2017-2018 - Covenant Healthcare Institute · Chapter 18 Assisting with Urinary Elimination Chapter 19 Assisting with Bowel Elimination Chapter 20 Assisting with Nutrition and Fluids

48

The student acknowledges receiving a copy of this completed agreement, the school catalog, and

written confirmation of acceptance prior to signing this contract. The student by signing this

contract acknowledges that he/she has read this contract, understands the terms and conditions,

and agrees to the conditions outlined in this contract. It is further understood that this agreement

supersedes all prior or contemporaneous verbal or written agreements and may not be modified

without the written agreement of the student and the School Official. The student and the school

will retain a copy of this agreement.

___________________________ __________ ____________________

Student’s Signature Date School Official Date