Student Application Forms 2026

Referral Form

Complete the form below.
Student Name:*

First NameLast Name
Email:*
Please provide complete mailing addresses of two family members or friends who may be in need of Career Training.
Referral 1:

First NameLast Name
Referral 1 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referral 1 Phone Number:
Please enter a valid phone number.
Referral 2:

First NameLast Name
Referral 2 Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referral 2 Phone Number:
Please enter a valid phone number.
In a few words, please indicate why this training program interests you and what your future goal is. This will be evaluated on clarity of expression, punctuation and content.

Education History Form

Complete the form below.
High School Graduation / Foreign High School / GED Certification Form
Student Name:*

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
State:
High School Last Attended:*
School Phone Number:
Please enter a valid phone number.
High School Address: Last Attended

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you graduate from High School?*

YesNo
Date Graduated:

MonthDayYear
Did you receive your High School Credential in a foreign country?*

YesNo
I received my High School Credential in:
Did you receive your GED?

YesNo
I received my GED on:*

MonthDayYear
Issuing State:*
Certification of Information

I certify that all information contained in this application is true and accurate. I understand that failure to provide true and accurate information may result in the rescission of CDE Career Institute's acceptance of my admission, disciplinary action up to dismissal, with no right of appeal or to a tuition refund, and/or loss of financial aid eligibility.
Signature of Applicant:*

Clear
Date*

MonthDayYear
Today's Date

High School Diploma and Transcript Request Form

Complete the form below.
I have enrolled in a diploma program at CDE Career Institute. CDE required proof of high school graduation; Therefore, I am requesting that you send an unofficial copy of my transcript to the campus admissions office.*

AgreeDisagree
Student Name:*

First NameLast Name
Date of Birth:*

MonthDayYear
Social Security #*
Phone Number:*
Please enter a valid phone number.
Email:*
Address:*

Street Address

Street Address Line 2

City

Zip Code
State:
School Information:
High School:
Graduation Date:

MonthDayYear
High School Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Phone Number:
Please enter the school phone number.
Fax Number
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Immunization and Hepatitis B Requirement

Complete the form below.
(Applicable to Internship at Hospitals ONLY)

I understand that as a result of my training in the Medical Transcription/ Insurance Billing Program I may suffer occupational exposure to blood and other potentially infectious materials during my internship rotation which can put me at risk of acquiring Hepatitis B Virus (HBV) infection.

As a preventive measure all students in Medical Transcription/Insurance Billing Program who are selected to fulfill their internship requirement at a hospital are required to adhere to the "Medical Students Internship Requirement" notice distributed to them during orientation.

I understand that if I decline the immunization, I may not be able to attend an Internship site and would therefore be unable to complete my program of study that I have registered for.

I have read and understood the requirements for internship.
Student Name:*

First NameLast Name
Email:*
Start Date:*

MonthDayYear
Date
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Attendance and Satisfactory Academic Progress Policy

Complete the form below.
This Attendance and Satisfactory Academic Progress Policy will be applied consistently to all students:

Attendance:

Students are expected to attend as scheduled and are required to contact the school if they will be absent. This contact should occur on the first day of absence.

The school regards students who miss scheduled class time to be absent for those clock hours. The school does not distinguish between types of absences. Any student who misses scheduled class time is expected to schedule make up time with their class instructor. Days that the school is closed ore days covered by an approved leave of absence need not to be made up.

Students that are absent for 14 (Fourteen) consecutive calendar days without an approved leave of absence will be at risk of losing their title IV funding eligibility. Students who lose their funding eligibility will be administratively withdrawn and will be billed for any remaining balances due to CDE Career Instituter in accordance with the student's enrollment agreement.

Maximum Time Frame for Completion:

Each student has a prescribed enrollment period which specifies his or her Start date and expected Graduation date. Student are expected to complete their training by their graduation date. Periods of non-enrollment such as an approved leave of absence are not included as part of the Maximum Time Frame. Students enrolled in a program are allowed no more than 150% of their program's published number of weeks in which to meet all requirements for graduation. Failure to meet graduation requirements within the maximum time frame for completion will result in administrative withdrawal.

Satisfactory Academic Progress Review:

When students reach the calendar midpoint date of their program, a formal Satisfactory Academic Progress evaluation occurs. Progress is checked in three areas:
1. Attendance: Rate of attendance must be a minimum of 67% (Hours attended/Hours scheduled to attend) to retain Federal Student Aid Funding eligibility.
2. Grade Point Average (GPA): Must be 2.0 or above to retain Federal Student Aid Funding eligibility.
3. At the midpoint progress review students must have a minimum GPA of 2.0 AND must have attended a minimum of 50% of their program's published clock hours.
PC Application - 150 Hours
Medical Office Assistant - 195 Hours
Computerized Office Assistant - 465 Hours
Medical Transcription/Insurance Billing - 470 Hours

Students who do not pass the mid-point SAP review must immediately meet their instructor to create and comply with a make-up plan. Non-Compliance will result in loss of funding and administrative withdrawal.

Internships:

Students not meeting SAP standards will not be eligible for Internship/Externship and will receive an Incomplete (0) for that portion of their program.

Leave of Absence:

Time covered by an approved Leave of Absence does not count against student attendance requirements. Any student asking for a Leave of Absence, or requiring adjustments to your schedule, must submit a request in writing and in advance. Please refer to your school catalog for our Leave of Absence and schedule change policy.
Student Name:*

First NameLast Name
Email:*
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Disclosures for Prospective Students and Employees

Complete the form below.
CAMPUS SECURITY INFORMATION

The school prepares a report to comply with the Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act (Clery Act). This report is prepared in cooperation with local law enforcement agencies. Nothing in the law shall be construed to permit a school to retaliate, intimidate, threaten, coerce, or otherwise discriminate against any individual with respect to the implementation of the Clery Act.

This report includes statistics for the previous three years concerning reported crimes that occurred on-campus; in certain off-campus buildings or property owned or controlled by the school; and on public property within, or immediately adjacent to and accessible from, the campus (as applicable). The report also includes institutional policies concerning campus security, such as policies concerning sexual assault, and other matters.

Enrolled students, faculty and staff are notified annually of this report.

All prospective students and employees may obtain a copy of the report from the President Mrs. Tina Albright which is also available on the school website at www.cde.edu

IMPROVEMENTS TO ACADEMIC PROGRAMS

The school reviews its academic programs on a regular basis to ensure relevancy with current employment requirements and market needs. As deemed appropriate, the school may change, amend, alter or modify program offerings and schedules to reflect this feedback. If you have questions about this process, contact the Education Department.

COPYRIGHT INFRINGEMENT

Students should be aware that the unauthorized distribution of copyrighted material, including unauthorized peer-to-peer file sharing, is subject to civil and criminal liabilities. Penalties may include monetary damages, fines and imprisonment. The school prohibits use of its computers and computer networks for the unauthorized downloading and uploading of copyright-protected material, or for maintaining or storing unauthorized copyright-protected material. Disciplinary action, up to and including expulsion from the school, will be taken against students who engage in unauthorized distribution of copyrighted materials using the school's information technology system.

STUDENT DEMOGRAPHIC INFORMATION

Information about the composition of the students at our school is available on the College Navigator website (www.nces.ed.gov/collegenavigator). College Navigator is maintained by the U.S. Department of Education National Center for Educational Statistics. To view information about our school, enter our school name into the search tool. Here are a few highlights of information that you will find within the various sections:
- Enrollment: gender and race/ethnicity distribution of students
- Financial Aid: data regarding the various financial aid sources for students, including federal grants (Pell)
- Retention/Graduation Rate: Retention rate of certificate, first-time, full-time, undergraduate students
The Career Services Department serves as a liaison between students and employers, serving the students by promoting the School to prospective employers. For additional information, contact the Career Services Department staff.

VACCINATIONS

Good health practices are encouraged for all students. However, the School does not require any specific vaccinations beyond those required by state and other laws as a condition for admission. The Medical Transcription/Insurance Billing program requires a vaccination before starting the internship course. A notice explaining this is given to students upon enrollment. Students are encouraged to consult with their health care professional to discuss obtaining or updating vaccinations.

Certification

I have read, understood and agree to the disclosures listed above.
Student Name:*

First NameLast Name
Email:*
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Student Disclosure

Complete the form below.
Employment Opportunities

Hospitals, Doctor’s Offices, Long Term Care Facilities, Nursing Homes, Outpatient Clinics, Rehabilitations Facilities, etc…

CDE Career Institute Culture Performance Statistics 2024/2025

*Completion Rate: 78.00%

*Placement Rate: 72.00%

*Meets or exceeds State and Accrediting Agency benchmarks

Gainful Employment

Year: 2017 Program: MTIB | Debt-to-Earnings Annual: N/A

Year: 2017 Program: COA | Debt-to-Earnings Annual: N/A

On Campus Crime & Safety Statistics

As of July 1, 2024 the school has records of the following violations during the following periods:

7/1/21 thru 6/30/22 | None reported

7/1/22 thru 6/30/23 | None reported

7/1/23 thru 6/30/24 | None reported

7/1/24 thru 6/30/25 | None reported
Student Name:*

First NameLast Name
Email:*
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date
Parent Signature:*

Clear
Date:*

MonthDayYear
Today's Date
Todays Date Calculation var

MonthDayYear
Calculated Age

Pre-Enrollment Receipt

Complete the form below.
Student Name:*

First NameLast Name
Email:*
Program:
I have received written information concerning the following topics prior to signing my contract. I have also received a copy of the completed enrollment agreement.

Please Initial each below:
Initial Here* School Catalog
Initial Here* School's Completion/Graduation Rate
Initial Here* School's Job Placement Rate
Initial Here* Copy of completed Enrollment Agreement
Initial Here* Satisfactory Academic Progress Policy
Initial Here* Gainful Employment Disclosures
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Talent, Verbal and Written Release

Complete the form below.
For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged: I hereby grant to CDE CAREER INSTITUTE, its clients, agents and representatives (CDE CAREER INSTITUTE) the absolute and irrevocable right and permission, in regard to photograph and/or film and video footage taken of me or in which I may be include with others, and/or the verbal or written statement or recording made by me or attributed to me, to copyright the same; to use and publish the same in whole or part, in advertising, illustration, promotion, trade, or any other lawful purpose whatsoever; to use my name in connection therewith if they so choose; and to use said photographs and or film and video footage and/or statement or recording in conjunction with my voice or in conjunction with the voice or photographs and/or film and videos of others if it has been recorded with my knowledge. I agree that CDE CAREER INSTITUTE shall be exclusive owner of the results and proceeds of such materials and use thereof. I realize that in taking and/or utilizing photographs, tape and/or recordings of me, which is at substantial cost to CDE CAREER INSTITUTE, CDE CAREER INSTITUTE is relying upon the rights granted to it under the release.

I hereby release and discharge CDE CAREER INSTITUTE from, and waive any and all claims, liabilities, actions, costs and expenses whatsoever, at law or in equity, know or unknown, anticipated or unanticipated, which I ever had, now have or may have in the future, arising out of or in conjunction with the photographing, taping and/or recording of me or the use of any of the materials described above or my name, statements and or autobiographical information, including without limitation any and all claims for libel, defamation, false light, copyright infringement, rights of publicity and/or invasion of privacy.

I hereby waive any right to inspect or approve the finished product. I am of full age, have read the foregoing, and fully understand the contents thereof. This release shall be binding upon me and my heirs, legal representatives, and assigns.
Student Name:*

First NameLast Name
Email:*
Address:*

Street Address

Street Address Line 2

City

Zip Code
State:
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Student Conduct Requirements

Complete the form below.
Students are expected to dress and act in a business-like manner while on campus or attending classes. At the discretion of the school administration, students may be dismissed from school for a serious incident or a repeated incident of an intoxicated or drugged state of behavior, possession of drugs or alcohol on school premises, possession of weapons on school premises, behaviors creating a safety hazard to other persons at the school, disobedient or disrespectful behavior to other students, an administrator, or faculty member, failure to conform to building policies, or any other stated or determined infraction of conduct.

Refunds for students terminated for Conduct Requirements infractions will be made according to the guidelines in the Cancellation and Refund Policy

I acknowledge that I have received and understand CDE Career Institute's Student Conduct Requirements.
Student Name:*

First NameLast Name
Email:*
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Media Services Orientation Form

Complete the form below.
To all CDE Students and Staff:

The Media Services Center is designed to provide you a dedicated space where CDE students and staff can reference learning materials relevant to appropriate careers, professional development and academic programs. The Media Center may also be used for electronic job search and resume submission.

You may access Media Center resources during regular school hours. Please sign in on the sheet provided and adhere to the following Media Center Rules.
1. CDE students may not bring outside media storage into CDE. If you need a device for storing media center resources, one will be provided to you.
2. CDE students may not download any software on to the Media Center
  computer.
3. The Media Center computer is not to be used for gaming or other personal purposes.
4. Media Center publications are to be left in the Media Center.
Additional Media Resources are available and provided though CDE's online learning platform. Media Center evaluation forms are available in the

Media Center and we encourage you to fill them out. You may give them to any member of the CDE staff or you may mail them directly to the Director at your campus.
Student Name:*

First NameLast Name
Email:*
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date
Staff Use Only:

To be completed by staff.
Staff Signature:

Clear
Date

MonthDayYear

Accuracy and Validity of Information Provided

Complete the form below.
Student Name:*

First NameLast Name
Email:*
I hereby certify that all information provided in my paperwork and documentation to CDE CAREER INSTITUTE is accurate, correct and freely given without any dictation, advice or pressure from any CDE CAREER INSTITUTE'S employees. I also understand that any false statements, answers or any misleading information may be sufficient grounds for my prosecution in addition to my immediate dismissal at any time from the college.
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date
Approved By:

To be completed by staff.
Witness Signature:

Clear
Date

MonthDayYear

Admission Presentation Receipt/Signature Form

Complete the form below.
Student Name:*

First NameLast Name
Email:*
Agreement Statement:
I certify that I have received a copy of the Admissions presentation/school catalog and understand all of the material presented to me upon enrollment.*

Yes, I agree with the statement above.No, I do not agree with the statement above.
Student Signature:*

Clear
Date*

MonthDayYear
Today's Date

Uploads and Attachments

Upload photos and or documents below.
Upload Files and or Documents (including your: ID and or High School Diploma.
File Upload

Cancelof
Take Photos Using Your Phone:
Should be Empty:

Student File Checklist

What State do you live in?

Race/Ethnic Group

Program / Time

Admission Application

Education History

Race/Ethnic Group

Referral Form

Please provide complete mailing addresses of two family members or friends who may be in need of Career Training.

Education History Form

High School Graduation / Foreign High School / GED Certification Form

Certification of Information

High School Diploma and Transcript Request Form

School Information:

Emergency Medical Statement

Emergency Information

Medical Information

Agreement Statement:

Immunization and Hepatitis B Requirement

Attendance and Satisfactory Academic Progress Policy

Disclosures for Prospective Students and Employees

Student Disclosure

Pre-Enrollment Receipt

I have received written information concerning the following topics prior to signing my contract. I have also received a copy of the completed enrollment agreement.

Talent, Verbal and Written Release

Student Conduct Requirements

Media Services Orientation Form

Staff Use Only:

Accuracy and Validity of Information Provided

Approved By:

Admission Presentation Receipt/Signature Form

Agreement Statement:

Uploads and Attachments

Upload Files and or Documents (including your: ID and or High School Diploma.