top of page

Enrollment Form

Entrance Interview

Have you ever used the services of Holistic/Alternative Techniques, Counseling, or Therapy
Yes
Do you have any training, skills or interest related to this field of study?
Yes
Explain
Are you comfortable talking to others in a therapeutic professional setting?
Yes
Are you currently employed?
Yes
Do you want to work for...
Self-employed
Do you seem to switch jobs a lot?
No
Did you enjoy school?
Yes
Did you join any school activities?
No
Are you good at taking directions from others?
Yes
Do you complete tasks?
Yes
Are you flexible?
Yes
Have you ever been convicted of a crime?
No
Do you have a drug or alcohol problem?
No
Give me two reasons why you should be admitted to this training program?
Are there any health concerns you would like to see improved through the information obtained during your eduction/training?
Yes
Are you currently taking any prescribed medication?
No

Entrance Examination

This exam is in two parts. The first part is to determine your ability to get along with and motivate (understand) people. The Second part is an essay form to review in part, your present knowledge, understanding of the Healing Arts & Sciences and how the alternative / holistic approach to health can help individuals.
Part One
1. All people like to be told what to do and how to live their lives.
False
2. Some people are considered oppositional, that is, they will do the opposite of what they are asked to do.
True
3. People will change their habits only when they are ready to change.
True
4. One of the most important areas in therapy is to determine what motives or drives a person to act.
True
5. A successful way to motive someone is to find out what is important to him or her first. Then motivate to their importance, rather than your own opinion.
True
6. It is much easier to predict what a group of people will do rather than an individual.
True
7. Some people are more of an analytical nature and some are more of an emotional nature.
True
8. An individual’s childhood, including family structure and school experiences can have a dramatic effect later in adulthood.
True
9. Some people can be classified as passive and same as taking charge.
True
10. Communication and a sincere interest in helping others improve their quality of life are important attributes of a successful therapist
True
Part Two
Please answer the following questions. Be thorough. Answer with as much detail as possible.
Referring to your chosen career, as a Holistic Health Practitioner, Behavioral Therapist, Clinical Hypnotherapist, Life Coach, Aromatherapist, or Master Herbal Practitioner.
Application / Enrollment
Agreement for Admission
Be sure to read all pages of this agreement and initial where indicated. It is part of your contract with the school.
In case of emergency, please notify (Name of nearest relative):
Educational Experience: List your prior Education: (including High School, College, University and other Training Programs)
Do you have a physical or learning disability?
Yes
Are there health concerns that would limit your ability to successfully participate in the activities of course?
No

(highest level of education completed)

BE SURE TO READ ALL PAGES OF THIS AGREEMENT. IT IS PART OF YOUR CONTRACT WITH THE SCHOOL

Page 1 of 6

EDUCATIONAL and INSTRUCTIONAL SERVICES are provided by California Institute of the Healing Arts & Sciences (CIHAS), 2377 Gold Meadow Way, Suite 100, Gold River (Sacramento,) CA 95670, as a Distance Learning Training Program through ZOOM.

Programs or Classes are held on the following:
Sat
Enrollment Agreement Period PROGRAM
Enrollment Agreement Period CLASSES

PLEASE NOTE

Read completely and retain a copy for your records. This Application/ Enrollment Agreement contains important information. You should have already received a school catalog. If not, Please go to the home page {upper right hand corner at: www.Californialnstitute.net and print and save, or review and save on your computer. If this is not possible, please request one. Please review this information and material, as it contains important school policies and procedures that every student needs to become familiar with. We look forward to issuing your Diploma(s), Certificate(s), Transcript, and any CEU's when you complete your program(s) or class(es), when any requested paperwork is complete, and all of your account with CIHAS is paid in full.

 

STUDENT'S RIGHT TO CANCEL   REFUND POLICY

1.   You have the right to cancel your agreement for a program of instruction, without any penalty or obligations, through attendance at the first-class session or the seventh calendar day after enrollment, whichever is later. After the end of the cancellation period, you also have the right to stop school at any time; and you have the right to receive a pro rata refund if you have completed 60 percent or less of the scheduled days/hours in the current payment period in your program through the last day of attendance.

Cancellation of this agreement can occur up to 7 days after enrollment without penalty:

2.   Cancellation may occur when the student provides a written notice of cancellation at the following address: 2377 Gold Meadow Way Suite 100, Gold River, CA 95670. This can be done by email, mail, or by hand delivery.

3.   The written notice of cancellation, if sent by mail, is effective when deposited in the mail properly addressed with properpostage.

4.   The written notice of cancellation need not take any particular form and, however expressed, it is effective if it shows that the student no longer wishes to be bound by the Enrollment Agreement.

5.   If the Enrollment Agreement is cancelled the school will refund the student any money he/she paid, less a registration fee and TFC administration fee not to exceed $250.00, and less any deduction for equipment not returned in good condition, within 45 days after the notice of cancellation is received.

 

WITHDRAWAL FROM THE PROGRAM (MUST BE IN WRITING)

You may withdraw from the school at any time after the cancellation period (described above) and receive a pro rata refund if you have completed 60 percent or less of the scheduled days/hours in the current payment period in your program through the last day of attendance. The refund will be less a registration or administration fee not to exceed $250.00, and less any deduction for equipment or books not returned in good condition, within 45 days of withdrawal. If the student has completed more than 60% of the period of attendance for which the student was charged, the tuition is considered earned and the student will receive no refund.

 

For the purpose of determining a refund under this section, a student shall be deemed to have withdrawn from a program of instruction when any of the following occurs:

  • The student notifies the institution of the student's withdrawal or as of the date of the student's withdrawal, whichever is later.

BE SURE TO READ ALL PAGES OF THIS AGREEMENT. IT IS PART OF YOUR CONTRACT WITH THE SCHOOL

Page  2 of 6

  • The institution terminates the student's enrollment for failure to maintain satisfactory progress; failure to abide by the rules and regulations of the institution; absences in excess of maximum set forth by the institution; and/or failure to meet financial obligations to the School.

  • The student has failed to attend class for three (3) consecutive weeks.

  • The student fails to return from a leave of absence.

For determining the amount of the refund, the date of the student's withdrawal shall be deemed the last date of recorded attendance. The amount owed equals the daily charge for the program (total institutional charge, minus non-refundable fees, divided by the number of days/hours in the program), multiplied by the number of days/hours scheduled to attend, prior to withdrawal. For the purpose of determining when the refund must be paid, the student shall be deemed to have withdrawn at the end of three (3) consecutive weeks. If the student has completed more than 60% of the period of attendance for which the student was charged, the tuition is considered earned and the student will receive no refund.

 

If any portion of the tuition was paid from the proceeds of a loan or third party, the refund shall be sent to the lender, th ird party or, if appropriate, to the state or federal agency that guaranteed or reinsured the loan. Any amount of the refund in excess of the unpaid balance of the loan shall be first used to repay any student financial aid programs from which the student received benefits, in proportion to the amount of the benefits received, and any remaining amount shall be paid to the student. 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.

 

DISTANCE EDUCATION PROGRAMS

STUDENT'S RIGHT TO CANCEL

This institution offers distance educational programs where the instruction is not offered in real time. The Institution shall transmit the first lesson and any materials to any student within seven days after the institution accepts the student for admission.

 

The student has the right to cancel the agreement and receive a full refund before the first lesson and materials are received. Cancellation is effective on the date the written notice of cancellation is sent to: 2377 Gold Meadow Way, Suite 100. Gold River, CA 95670. If the institution sends the first lesson and materials before an effective cancellation notice was received, the institution shall make a refund within 45 days after the student's return of the materials.

Cancellation of this agreement can occur up to 7 days after enrollment without penalty:

This Institution shall transmit all of the lessons and other materials to the student if the student (a) has fully paid for the educational program; and (b) after having received the first lesson and initial materials, requests in writing that all of the material be sent. If the Institution transmits the balance of the material as the student requests, the Institution shall remain obligated to provide the other educational services it agreed to provide, such as responses to student inquiries, student and faculty interaction, and evaluation and comment on lessons submitted by the student, but shall not be obligated to pay any refund after all of the lessons are material are transmitted.

 

WITHDRAWAL FROM THE PROGRAM

You may withdraw from the school at any time and receive a pro rata refund if you have completed 60 percent or less of the scheduled days in the current payment period in your program through the last day of attendance. The refund will be less a registration or administration fee not to exceed $250.00, and less any deduction for books and materials not returned in new condition as stated as refundable on the enrollment agreement. A refund will be made within 45 days of withdrawal.

 

For the purpose of determining a refund under this section, a student shall be deemed to have withdrawn from a program of instruction when any of the following occurs:

  • The student notifies the institution of the student's withdrawal or as of the date of the student's withdrawal, whichever is later.

  • The institution terminates the student's enrollment for failure to maintain satisfactory progress; failure to abide by the rules and regulations of the institution; and/or failure to meet financial obligations to the School.

 

For the purpose of determining the amount of the refund, the date of the student's withdrawal shall be deemed the last date of recorded attendance. The amount owed equals the daily charge for the program (total institutional charge, minus non-refundable fees, divided by the number of days in the program), multiplied by the number of days scheduled to attend, prior to withdrawal. For distance education students scheduled days is based on one day a week, which include is Saturday. A complete class schedule is given to the student upon enrollment and can be requested at any time. (Which includes holidays.) (specific holidays published in the catalog).

 

lf any portion of the tuition was paid from the proceeds of a loan or third party, the refund shall be sent to the lender, third party or, if appropriate, to the state or federal agency that guaranteed or reinsured the loan. Any amount of the refund in excess of the unpaid balance of the loan shall be first used to repay any student funding programs from which the student received benefits, in prop ortion to the amount of the benefits received, and any remaining amount shall be paid to the student. 

BE SURE TO READ ALL PAGES OF THIS AGREEMENT. IT IS PART OF YOUR CONTRACT WITH THE SCHOOL

Page 3 of 6

Itemization and Total Tuition Fees - Current Expenses

Please note: each field is required below, you should have received information from administration as to what to enter in these fields. If it does not apply to you please mark as N/A or $0 to prevent an error is submission.

Registration
Non-refundable - due upon enrollment ($100)
STRF
0.0005.% per $1,000, for CA Residents only. Non Refundable. 
Books & Materials
Included
Shipping
Shipping Fees are Non-Refundable
Admin Fee
Add 10% of balance due for payment plans (non-refundable)
Deposit
Total Down Payment Charge Upon Enrollment
Total Charges For The Current Period Of Attendance
Total Charges for Program
Estimated total charges for the entire education program
Balance Due Payment Plan
Balance (Tuition - tuition PP deposit)
Balance divided by (x)____ for amount per Month
TFC Financing-attached truth & lending part of enrollment agreement
 (payment amount multiplied by months)
Total Charges
Total charges student is obligated to pay upon enrollment
Approved 3rd Party Payment
Responsible for total charges:

THE TERMS AND CONDITIONS OF THIS AGREEMENT ARE NOT SUBJECT TO AMENDMENT OR MODIFICATION BY ORAL AGREEMENT. I, THE UNDERSIGNED PURCHASER OF THE PROGRAM OF TRAINING, HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS CONTAINED HEREIN AND WITH MY SIGNATURE I CERTIFY HAVING RECEIVED AN EXACT COPY OF THIS AGREEMENT, A COPY OF THE SCHOOL CATALOG AND SCHOOL PERFORMANCE FACT SHEET. I FURTHER ACKNOWLEDGE THAT NO VERBAL STATEMENTS HAVE BEEN MADE CONTRARY TO WHAT IS CONTAINED IN THIS AGREEMENT. THIS ENROLLMENT AGREEMENT IS A LEGALLY BINDING INSTRUMENT WHEN SIGNED BY THE STUDENT AND ACCEPTED BY THE SCHOOL.

 

I understand that this is a legally binding contract. 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. 

image (1).png

Carol DiGirolamo, Director

BE SURE TO READ ALL PAGES OF THIS AGREEMENT. IT IS PART OF YOUR CONTRACT WITH THE SCHOOL

Page 4 of 6

UNDERSTANDINGS

Catalog: Information about CIHAS is published in a school catalog that contains a description of certain policies, procedures, and other information about the school. ClHAS reserves the right to change any provision of the catalog at any time. Notice of changes will be communicated in a revised catalog, an addendum or supplement to the catalog, or other written format. Students are expected to read and be familiar with the information contained in the school catalog, in any revisions, supplements and addenda to the catalog, and with all school policies. By enrolling in CIHAS, the Student agrees to abide by the terms stated in the catalog and all school policies.

Location: All residential instruction occurs at the address checked on Page I of this agreement. Distance education coursework is completed at a location determined by the student.

I understand that I will be awarded a Certificate/Diploma when I have completed all of the program requirements. A graduate must have passed each course and have satisfied all financial obligations.

NOTICE CONCERNING TRANSFERABILITY OF CREDITS AND CREDENTIALS EARNED AT OUR INSTITUTION: The transferability of credits you earn at CIHAS is at the complete discretion of an institution to which you may seek to transfer with credits from this Institute. Acceptance of the certificate/diploma you earn in the program you are enrolled in is also at the complete discretion of the institution to which you may seek to transfer. If the certificate/diploma that you earn at this institution is not accepted at the institution to which you seek to transfer, you may be required to repeat some or all of your coursework at that 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 CIHAS to determine if your credits, or certificate/diploma will transfer.

Career Services: Placement assistance is not provided. It is understood that the School does not and cannot promise or provide employment nor level of income or wage rate to any Student or Graduate because these programs are for selfemployment for Graduates to engage in a Private Practice.

Questions: 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 2535 Capitol Oaks Drive, Suite 400, Sacramento, CA 95833, www.bppe.ca.gov, toll-free telephone number (888) 370-7589 or by fax (916) 263-1897.

Complaints: A student or any member of the public may file a complaint about this institution with Bureau for Private Postsecondary Education by calling 888.370.7589 toll-free or by completing a complaint form, which can be obtained on the bureau's Internet Web site, www.bppe.ca.gov.

Financing: The Student understands that if a separate party is financing his/her education, that the Student, and the Student alone, is directly responsible for all payments and monies owed to the school listed on this agreement.

Books/Supplies/Equipment: The supplies for the Clinical Hypnotherapist, Life Coach, Behavioral Therapist, and Holistic Health Practitioner programs selected will be provided by the School at the stated charge. In the Herbal Medicine Programs, students will purchase herbs, books and supplies from vendors of their choice, at their expense. Lost, mutilated, or stolen items will be replaced at the expense of the student.

Distance Education Equipment Requirements provided bv STUDENT: working computer, on-line internet access, Web-ex software access, Zoom, or comparable software, a printer, camera on computer monitor and audio capabilities.

Student Tuition Recover Fund: "The State of California established the Student Tuition Recovery Fund (STRF) to relieve or mitigate economic loss suffered by a student in an educational program at a qualifying institution, who is or was a California resident while enrolled, or was enrolled in a residency program, if the student enrolled in the institution, prepaid tuition, and suffered an D economic loss. Unless relieved of the obligation to do so, you must pay the state-imposed assessment for the STRF, or it must be paid on your behalf, if you are a student in an educational program, who is a California resident, or are enrolled in a residency program, and prepay all or part of your tuition.(at the current time the collection fee is 0.0005. for every $1,000 CA Residence). You are not eligible for protection from the STRF and you are not required to pay the STRF assessment, if you are not a California resident, or are not enrolled in a residency program."

BE SURE TO READ ALL PAGES OF THIS AGREEMENT. IT IS PART OF YOUR CONTRACT WITH THE SCHOOL

Page 5 of 6

NOTICE
YOU MAY ASSERT AGAINST THE HOLDER OF THE PROMISSORY NOTE YOU SIGNED. IN ORDER TO FINANCE THE COST OF INSTRUCTION ALL OF THE CLAIMS AND DEFENSES THAT YOU COULD ASSERT AGAINST THIS SCHOOL, UP TO THE AMOUNT YOU HAVE ALREADY PAID UNDER THE PROMISSORY NOTE.

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, and 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.

BE SURE TO READ ALL PAGES OF THIS AGREEMENT. IT IS PART OF YOU