Nurse Aide Training Application Form Southern Indiana Medical Education Center Application Form "*" indicates required fields Select Program* Nurse Aide Training - Standard Nurse Aide Training - 2.0 Select Start Date* January 13, 2025 March 17, 2025 July 28, 2025 September 29, 2025 Name* First Middle Initial Last Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Current Employer *If your current employer is paying tuition, contact the administrative office for tuition payment prior to the course start date.Scrub Set Size*SizeSmallMediumLargeX-LargeXXLXXXLHow did you hear about us?*EmployerFacebook/MetaInstagramOnline SearchFriend/Other PersonYouTubeOtherSelect Payment Option* I select to pay full tuition I select the Payment Plan Other Payment due before the start date.Terms & Conditions* I agree to the terms & conditions Terms & Conditions The following Terms & Conditions shall apply to this website (https://simeconline.com) and all interactions with Southern Indiana Medical Education Center (“SIMEC”, “We”, “Our”). Please read these terms carefully as they set forth the rights and responsibilities of SIMEC and its students, applicants, and other users of this website. By using our website or contacting us about our courses, you hereby agree to the terms set forth below. PLEASE READ THESE TERMS IN FULL BEFORE USING OUR SITE OR SERVICES. Website Content 1. The content (e.g., text, images, video, applications) on the SIMEC website may not be reproduced or republished, either online or offline, without SIMEC’s express consent. You may link to the website content as long as: ● You do not state or imply that SIMEC is endorsing any third-party products and/or services; ● You do not misrepresent your relationship with SIMEC or present any false information about SIMEC; ● Your site does not publish content that is in breach of intellectual property rights; that is illegal, discriminatory, harassing, libelous, proposes the use of alcohol, drugs, or tobacco, or creates a hostile environment; that is inappropriate for children; or that is on pages that contain computer viruses, Trojan horses, corrupted data or other potentially harmful software or data. 2. We do not guarantee that the content on the SIMEC website is complete or correct, and we may make changes to the website content at any time and without notice. 3. We shall not be liable or responsible for any kind of loss or damage that may occur as a result of your use of the SIMEC website. 4. You agree that we may, in our sole discretion, terminate or suspend your access to all or part of SIMEC website with or without notice and for any reason, including, without limitation, breach of these terms and conditions of use. Website Privacy 1. SIMEC is committed to maintaining your privacy. If we request information from you, we will not provide that information to any third party, unless necessary to complete your application and/or enrollment. 2. To complete your application and/or enrollment into SIMEC courses, we will request the following information from you via our online application: ● Name ● Email Address ● Phone Number ● Mailing Address ● Date of Birth ● Credit Card or other payment information 3. We reserve the right to request additional information if necessary to complete your application for enrollment in SIMEC courses. Course Eligibility By using this website, you acknowledge the eligibility requirements listed below, which will be used in part to determine candidates’ enrollment into one of our courses. To be considered for enrollment into our Nurse Aide Training, candidates must: ● Be 17 years of age ● Be able to read & write English (verified by pre-admission exam) ● Be able to do simple mathematics (verified by pre-admission exam) ● Be physically able to carry out the duties of a nurse aide SIMEC will also select candidates for its courses based on their qualifications and ability to succeed in the course of their choice. SIMEC reserves the right to determine which applicants will be invited to enroll based on their eligibility and other qualifications. Tuition Payment 1. Payments for tuition and SIMEC merchandise will be accepted only through the simeconline.com website or designed third party. 2. All transactions will be carried out through a third-party payment processor to best protect your payment information. 3. The cost of the training will be divided into three equal payments. The first (1st) payment for the Nurse Aide Training is due before the start of the course; the second (2nd) payment is due before the start of the third week, and the third (3rd) and final payment is due before the start of the clinical training. If any payment is delinquent, you cannot proceed with the Nurse Aide Training until all accounts have been settled. 4. Upon completion of payment(s), students will gain access to course materials. 5. All applicants and students acknowledge that if they are delinquent on any tuition payment, they will not be able to proceed with the training and will forfeit their eligibility to graduate until all accounts have been settled and may be able to attend the next rotation of clinical training. Refunds & Termination 1. If a student has paid for tuition in full before the start of Nurse Aide Training, the student may be eligible for a refund within the first week of the curriculum. 2. An administrative fee of $150 will be deducted from the tuition and may take up to 6 weeks to process. 3. No refund is given if the withdrawal request is made after the first week of the curriculum. 4. The application fee is non-refundable in any event. 5. No refund is given if termination by the school for any Code of Conduct violation. Photo Release Students enrolled in SIMEC courses may be photographed while attending the training. SIMEC reserves the right to use such photographs in copy, print, or other materials on its website, publications, and other media. Students acknowledge and agree to release any and all rights to photographs taken during training and understand that such photographs will belong solely and exclusively to SIMEC, which shall have the absolute right to copyright, duplicate, reproduce, alter, display, distribute, and/or publish them in any manner, for any purpose, and in any form. Release of Liability & Assumption of Risk By accessing this website, you agree to release SIMEC and any related third parties from responsibility in the unlikely event of accidents on campus during training or instruction. You further agree that you have valid medical insurance that would provide coverage to students in case of a medical emergency. Governing Law This Agreement shall be governed by the laws of Indiana. Privacy Policy SIMEC is committed to protecting the privacy of any personal information you provide to us and our representatives. Please see our Privacy Policy for detailed information on how we maintain the privacy of any information you share with us. Coupon Code Application fee (non-refundable)* Price: Credit Card*Card Number Cardholder Name EmailThis field is for validation purposes and should be left unchanged. Δ
