• CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Enrollment Agreement

  • Applicant Information

  • Date of Birth:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Is this is a mobile number? *
  • Format: (000) 000-0000.
  • Is this is a mobile number?*
  • Program Information:

    In an effort to keep the curriculum current, CDE Career Institute reserves the right to change program content, material and textbooks, under the guidelines set by the NJ Department of Labor and Workforce Development, no additional charges are made to students for these types of changes. A Certificate will be issued upon completion of the chosen Program provided that all graduation requirements have been met. All programs are expressed in clock hours. One clock hour consists of 50 minutes of instruction within a 60 minute period. A description of each program may be found in the School Catalog.
  • Enrollment Period / Attendance Schedule:

    CDE Career Institute offers individualized enrollment periods and attendance schedules. The minimum attendance schedule consists of twenty four (24) hours per week. CDE does not recommend attendance schedule modification once the enrollment period has begun. However, if you must change your schedule, you must submit the requested changes, in writing to your instructor and have it approved in writing prior to the change. If the school is able to accommodate the request, based on seating availability, the Enrollment Agreement will be updated to include the modified schedule and enrollment period. Schedule change forms must be signed by the student and CDE staff and will be retained with the Enrollment Agreement.
  • Enrollment Period:

  • Start Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Calendar Mid Point:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Grad/End Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Attendance Schedule:

  • Schedule:*
  • Tuition and Fees

    TUITION: $800

    APPLICATION FEE: $

    BOOKS /Supplies: $

    TOTAL: $

  • Method of Payment
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Payment Plan Terms:

  • A payment of     will be made on the       of each       beginning on     Pick a Date   until payments or balance is paid in full. I understand that while a payment plan is 0% interest financing with CDE, I am contractually obligated to the payment schedule outlined above regardless of my schedule or actual attendance. I understand that my contract must be paid in full prior to my scheduled graduation date.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Cancellation/Refund Policy:

    CDE Career Institute refund policy is based on full‐time attendance in courses/programs exceeding 300 hours, but not exceeding 1200 hours (N.J.A.C. 12:41‐4.1). The school may retain the application fee and a portion of the monies paid for books, equipment and tools. The director of the school must be notified in writing within five (5) business days of the date of withdrawal. The school shall adhere to the following refund policy in the event of notification by the student of withdrawal from the school or termination by the school prior to completion of the course or program:
  • Time of Withdrawal

    Within three business days of signing this contract and before attending any classes

    After starting class, based on days attended

    After completing the full program

    All withdrawal notices must be submitted in writting to the school director within five (5) business days of the decision to withdraw. Refunds will be issued within 30 days of official withdrawal.

  • Student’s Responsibility

    $0 of total tuition (full refund), plus the non-refundable $100 registration fee

    $100 registration fee plus a daily tuition charge for each day attended (total tuition is divided equally across the program's scheduled days)

    100% of tuition and fees retained (no refund)

  • TEXTBOOK REFUNDS

    Refunds for books are only available if the book is returned in new condition within the students planned enrollment period. In the event that course materials substitutions are made within a student’s planned enrollment period, students will be provided with the new material at no additional charge.

  • REFUND PAYMENTS

    Refunds when due to students will be made within 30 days (1) of the last day of attendance if written notification of withdrawal has been provided by the student or (2) from the date the institution terminates the student of determines withdrawal by the student. Retention of tuition and fees collected in advance for a student who does not commence class shall not exceed $100.00.

  • All students are eligible for placement assistance services through CDE’s job placement resources. While placement assistance is always available, we cannot guarantee employment to any student. CDE Career Institute post-training placement information is available at https://mycareer.nj.gov.

  • COMPLAINT PROCEDURE

    Any questions or concerns regarding the information contained in the Enrollment Agreement must be directed to the School President, in writing. If these questions or concerns are not resolved to the applicant’s satisfaction, the applicant may bring the situation to the attention of the school’s licensing board: NJ Department of Labor and Workforce Development, Training Evaluation Unit. 1 John Fitch Plz, Trenton, NJ 08611

    The school also follows the policies of The Council on Occupational Education (C.O.E.) Complaints can be forwarded to C.O.E. at 40 Roswell Road, Building 300- Suite 325 Atlanta, GA 30353.

    Students must submit written complaints to the school director. The school director will notify the student, in writing, within Ten (10) business days of written complaint of the procedures that the student and administration will follow when resolving the student’s concerns.

  • The student agrees to maintain regular attendance and to abide by the rules and regulations off the school. The student understands that regular attendance is the obligation of the student and the school’s policy regarding absence and make-up as stated inn the school catalog will apply. Violation of school rules and regulations may subject the student to dismissal.

  • In the event of an unannounced school closure, students enrolled at the time of the closure must contact the Department of Labor and Workforce Development’s Training Evaluation Unit within 90 calendar days of the closure. Failure to do so within the 90 days may exclude the student from any available form of assistance. The contact number is (609)292-4287 or via email at trainingevaluationunit@dol.nj.gov.

  • The student acknowledges receiving a copy of this 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 and understands the terms and conditions and agrees to the conditions outlined in this contract. Signing of this contract by the school is written confirmation by the school that the above named student has been approved to enter the above named program(s). This agreement is not binding until three business days after signing by both parties. The student and the school shall retain a copy of this agreement.

  • I have read this agreement in its entirety and understand that this agreement, upon acceptance by the school as evidenced by the Official Signature and effective date below, constitutes a legal and binding contract between the school and the applicant or parent/guardian of the applicant. Upon successful completion of the Program that I have chosen, I will receive a Certificate of completion. All information in the agreement is true and correct to the best of my knowledge, I do hereby acknowledge receipt and do fully understand the school’s current school catalog as well as this agreement.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Gender:*
  • Age
  • Do you identify yourself as Hispanic or Latino?* *
  • Do you identify yourself as:*
  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Student Disclosure
  • Changing lives, One student at at time

    CDE Career Institute (CDE) offers a Phlebotomy Techniclan Program ( "The Program"), designed to prepare students for employment as Phlebotomists. As part of the program, Phlebotomy Technician program students ("Phlebotomy Students") are trained to draw and collect blood samples. In order for students to complete this training, volunteers are needed. lf you are willing to be a student Volunteer, please carefully review the information below and sign and date where indicated at the end of the forrn. Student volunteers must also have a Parent/ Guardian review and sign this form, unless the Student Volunteer is over 18 and no longer a dependant. 

     
    Informed Consent: By my signature below, I understand and agree as follows:

    1. l have read the information provided in this form and had the opportunity to ask any questions I have.

    2. I am providing my informed consent for the student Volunteer named below to participate as a volunteer in the program, by permitting a Phlebotomy Student to take a blood draw from the Student Volunteer under direct and close supervision of a program instructor.

    3.The Student Volunteer named below has no medical conditions that would be adversely impacted by his/her volunteer participation in the program. 

    Waiver of Liability and Release of Claims: By my signature below, l understand and agree as follows:

    1. I voluntarily assume any and all risk relating to the Student Volunteer's participation as a Student Volunteer in the program.

    2. I, my heirs, assigns and representatives herby release, waive, discharge, hold harmless, defend and indemnify CDE and/or the Program, their officers, agents, volunteers, and employees from any and all liablity, claims, demands, damages, fees or expenses, or actions whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by the Student Volunteer as a result of the Student Volunteer's participation in the program.

    3. The Program cannot be expected to control all the risk associated with this Proqram and that there may be the need for a response to accidents and potential emergencies. Therefore,  I give my consent for any medical treatment that may be required as determined by a medical professional during the Student Volunteer's participation as a volunteer in the program, with the understanding that I will be financially responsible for all cost of treatment.

    4. I have read this consent and Waiver and Release of Liability form, understand it and sign it voluntarily.

     

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Date:*
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    2 digit month, 2 digit day, 4 digit year
  • Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Todays Date Calculation var
     - -
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Authorization and Release

  • I, *, born in   *,   *, on   Pick a Date*   hereby authorize, for a period of (12) months beginning on the date of my completing any program offered by CDE Career Institute, (CDE) every employer, person, firm, company, corporation, governmental agency, association, or institution having control of any information regarding my earnings from employment held after the date of my completing any program offered by CDE to release this information to CDE. This information will include but is not limited to salary, hourly wage, bonus amount, and benefits.

    I understand that this authorization shall be in effect for twelve months after the date of me completing any program offered by CDE.

    I understand that CDE may make more than one request for information to the same party during the term of the authorization for the purpose of updating the records of CDE.

    I understand that this information may be reported to Workforce Investment, an agency of the State of New Jersey, the United States Department of Education and/or the Council on Occupational Education.

    I understand that CDE will not report this information to anyone other than Workforce Investment or the United States Department of Education or the Council on Occupational Education.

    I hereby, release, discharge, and exonerate CDE, its agents and representatives, and any person furnishing information from any and all liabilities of every nature and kind arising out of the furnishing and inspection of such information.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Information and Sharing

    The Family Education Rights and Privacy Act of 1974 (FERPA)
  • WHAT IS FERPA?

    The Family Rights and Privacy Act of 1974, as amended, (commonly known as the Buckley Amendment) is a federal law which provides that schools will maintain the confidentiality of student education records. The law basically says that no one outside the institution shall have access to student's education records nor will the institution disclose any information from those records without the written consent of students. There are exceptions, of course, so that certain personnel within the institution may see the records, including persons in an emergency to protect the health or safety of students or other persons.


    WHAT IS CONSIDERED DIRECTORY INFORMATION?

    In compliance with FERPA, the following statement reflects the school's policy: The following directory information may be released by phone: A) Student's dates of attendance; B) date of graduation and degree or certificate earned. Other kinds of directory information, such as a student's address, telephone listing, program of study, awards received, and the most recent previous education agency or previous institution attended, will be released only in response to a written request.

    The school reserves the right to refuse the above information if the reason for the request is not considered to be a sufficient need to know. Information regarding the student's record: Grades, courses, GPA, social security number and other personal information will not be released without the student's written consent.

    However, the Act states that each student has the right to inform the school that any or all of the information is not to be released. No information will be released without the written consent of the student. This status is binding until such time that CDE Career Institute is notified in writing by the student to permit release of " directory information".


    WHAT ABOUT...?

    At the postsecondary level, parents have no inherent rights to inspect a student's education record. The right to inspect is limited solely to the student. Records may be released to parents only under the following circumstances: (1) through the written consent of the student, (2) in compliance with a subpoena.

  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Family Educational Rights and Privacy Act

    Student Release
  • Student's Authorization for Disclosure

  • I hereby waive my rights under the Family Educational Rights and Privacy Act of 1974 (FERPA) and authorize CDE Career Institute to discuss and/ or disclose the following education records to the person listed below:
  • Format: (000) 000-0000.
  • I understand that this authorization will be in effect as long as I am a student at CDE Career Institute or until I revoke this authorization in writing.

    I affirm that I have carefully read the foregoing authorization and that I fully understand the meaning and intent of this document. I affirm that I have signed this authorization voluntarily.

  • Date*
     / /
    2 digit month, 2 digit day, 4 digit year
  • This authorization form is not required when school transmits to state and federal agencies concerning processing of Title IV aid. This authorization is not also required if student files are subject to institutional, state and federal program review and audit.

    Information Release Via Telephone

    No information concerning any student is released to any individual, group or organization via telephone, cellular or other similar devices unless that individual, group or organization is involved in the awarding and processing of student's Title IV aid.

  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Conduct Requirements

  • Students are expected to dress and act in a business-like manner while 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 buildings 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.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Mandatory Compliance with School Uniform Policy

  • As part of our commitment to maintaining the highest standards of professionalism and safety within the phlebotomy program at CDE Career Institute, we would like to reiterate that the wearing of school uniforms is mandatory for all students during classroom sessions. This policy is not only a reflection of CDE Career Institute commitment to professionalism but also a critical component of ensuring compliance with safety regulations outlined by the Occupational Safety and Health Administration (OSHA).

    Phlebotomy students, by the nature of their training, are required to handle blood and other potentially infectious materials. As such, strict adherence to OSHA guidelines is paramount to minimize the risk of exposure to bloodborne pathogens and to maintain a safe, hygienic learning environment. School uniforms are designed to offer both a professional appearance and practical protection. Proper attire serves as a barrier to contamination and ensures that the students are adequately safeguarded from any potential exposure during hands-on procedures.

    Failure to comply with this uniform policy not only undermines the integrity of the program but also exposes individuals to unnecessary safety risks. In keeping with OSHA's bloodborne pathogens standard, students must be dressed in appropriate attire that covers and protects the skin from potential contamination. CDE Career Institute uniforms, which are designed to meet these requirements, facilitate a safer and more professional environment for all students and staff.

    By signing below, you acknowledge that you fully understand the importance of this requirement and agree to comply with the school's uniform policy for the duration of your participation in the phlebotomy program. This signature serves as confirmation that you are aware of the potential safety risks involved and the necessity of adhering to both the uniform policy and OSHA regulations.

    We trust you understand the importance of these regulations and encourage you to approach your training with the utmost professionalism, including full adherence to uniform policies.

    Acknowledgment and Agreement

  • I,         , confirm that I have read and understood the mandatory uniform policy as outlined above and will fully comply with all requirements during my participation in the phlebotomy program. I acknowledge the importance of adhering to OSHA safety regulations and agree to wear the designated school uniform at all times during classroom sessions.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Telephone Use, Smoking Policy and Parking

  • While a student at CDE we ask you to keep personal phone calls to a minimum. Phone use is prohibited during class instruction. Personal calls may be made from the phone in your classroom with the prior permission of your instructor and when absolutely necessary or when the call relates to a job search. The calls should be limited to 5 minutes. Personal calls may be made from your cell phone but please be considerate of your fellow students. Please do not make a call or take a call or hold any conversations in the classroom, you must go outside or use the lounge area.

    Cell phones must be set to vibrate and should not ring in the classroom.

    Remember, time that you are signed in to class should be used for your classes, not wasted by spending a lot of time on the phone or chatting.

    Please do not use the restrooms as phone booths.

    Use of "Smart Phones" for internet browsing, social networking sites and texting are prohibited while in class. This is waste of class hours and not why you are here.

    Disregard for this policy may result in disciplinary action.

    CDE Career Institute maintains a Smoke Free Environment. There is absolutely no smoking on campus or near the front door.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Technology, Equipment and Internet Use Policy

  • Computers, computer files, school provided Internet access and software furnished to students are CDE property intended only for business use. Students should not create a password, access a file, or retrieve any stored communication, without a legitimate school purpose. No changes to passwords on CDE computers, or systems are to be made by any student.

    Computer viruses can seriously damage any organization's technology systems. Accessing personal emails and inserting non school storage devices into CDE computers, is strictly prohibited. This includes music and photos.

    CDE strives to maintain an educational environment free of harassment that is sensitive to the diversity of its students and employees. Therefore, CDE prohibits the use of computers, or other electronic systems in ways that are disruptive, offensive to others. For example, the display or transmission of sexually explicit images, messages, or cartoons is not allowed. Accessing dating or any social media sites is not allowed. Other such misuse includes, but is not limited to, ethnic slurs, racial comments, off- color jokes, or anything that may be construed as harassment or showing disrespect for others.

    CDE computer systems may not be used to solicit others for commercial ventures, religious or political causes, outside organizations, or other non- school matters.

    Additionally, students may not utilize their computers to play " computer games" or shop online. To ensure compliance with this overall policy, computer usage may be monitored. Students who violate this policy may be subject to disciplinary action, up to and including termination of enrollment.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Plan for Assuring the Routine and Emergency Health and Safety of Employees, Students and Guests

  • Purpose: The purpose of this plan is to assure the routine and emergency health and safety of the school's employees, students and guests. This plan is available to employees and students.

    CAMPUS SECURITY INFORMATION PROGRAMS

    Crime prevention and personal safety are issues that concern all students, faculty and administrative staff. It is the policy of CDE Career Institute that all students will receive a copy of the School Catalog prior to beginning classes. That Catalog will contain the Campus Security and Crime Awareness policies of the institution. These policies will be addressed during new student orientation. All new employees receive the CDE Career Institute School Catalog, containing the Campus Security and Crime Awareness policies of the institution. These policies will be addressed during new employee orientation, which is conducted by the Admissions Coordinator and / or Instructional staff. The institution has no responsibility or obligation for any personal belongings that are lost, stolen or damaged, whether on or off campus premises or during any school activities. All safety and security incidents will be recorded and on the Safety and Crime incident form and the form will be forward to the school President for review and filed by the Campus Safety and Security Official.

    The following Safety Policy and procedures have been implemented.

    CAMPUS SAFETY POLICY

    Medical Emergencies

    In the event of sickness or accident these procedures are to be followed:

    1. If you become ill or are injured in an accident on campus, notify your instructor immediately.
    2. If the illness or accident requires emergency care, the school will obtain emergency assistance by calling 9-1-1.
    3. The school will notify the individual you have designated as your Emergency Contact.
    4. First-Aid Kits are located throughout the Institution for minor emergencies. All staff members are aware of the location of the First - Aid Kits.
    5. In the event of illness or injury your instructor will complete an incident Report and submit that report to the Campus Director or his/her designee.


    FIRE EMERGENCY

    All students should familiarize themselves with the evacuation plans posted in the classrooms and throughout the building. In the event of a fire in the school building, students should:

    • Immediately notify an instructor so that a fire evacuation may be initiated if the alarm has not already sounded.
    • Remain calm; cooperate with the instructor and follow directions given.
    • Assist the instructor in closing all windows and doors behind you as you leave.
    • Craw low under the smoke to escape.
    • If escape through the doors is not possible, your instructor will assist you in exiting through the nearest unobstructed window.
    • If you clothing catches fire, stop right where you are. Drop to the ground. Roll over and over to put out the flames.
    • It is the responsibility of ALL students to follow these procedures. No student should leave his/her group and wander around the building alone. Students and instructors will gather in the front parking lot at a safe distance from the building following evacuation.

    NATURAL DISASTER

    In the event of natural disasters, the following procedures should be
    followed:

    FLOODS AND FLASH FLOODS:

    Stay inside. Do not evacuate unless you are told to do so.

    SEVERE THUNDERSTORMS AND LIGHTNING

    • Stay inside. Move away from windows, water faucets, sinks and metal objects.
    • Proceed in an orderly fashion to the inside hallway away from windows.
    • Do not use telephones.
    • Turn off computers and other electrical equipment you may be using.

    EMERGENCY EVACUATION FOR STUDENTS WITH SPECIAL NEEDS

    If you need special help or assistance during an emergency evacuation, be sure to tell your instructor.

    EVALUATIONS:

    The plan for assuring the routine and emergency health and safety of employees, students and guests is evaluated by the faculty, and staff, and staff annually.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Good Faith Agreement

  • Training Services

  • I,         understand that my goal in this training program is to gain employment related skills. In order to learn these skills in the the allotted training period, I realize that attendance is mandatory. Should I be forced to miss a schedule class session, I will call the school before the start of class to inform them of my absence.

    I also understand that my class schedule is set up as follows:
    Monday, Tuesday, Wednesday, Thursday, Friday

    with a start date of,   Pick a Date   and an anticipated graduation date on or before,   Pick a Date   

  • Placement Services

  • I,          understand that my goal in this program is to gain training- related employment, and I will fully cooperate with CDE Career Institute staff in doing so.

    Goverment funded Students: Gainful employment shall mean that I will adhere to the numbers of hours (i.e full-time) and the minimum, or higher, wage agreed to between the sponsoring agency and CDE.

    I understand that if I do not show good faith in my job search activities, I risk being denied by current training benefits, and I will be responsible for any remaining balance of tuition costs for my training.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Media Services Orientation Form

  • 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 disk 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 computers are not to be used for gaming or other personal purposes.
    4. Media Center publications are to be left in the Media Center.

    Media Center evaluation forms are available in the Media Center and we encourage you to fill them out. You may give them to any CDE staff member or you may mail them directly to the Director at your campus.

  • Date:*
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    2 digit month, 2 digit day, 4 digit year
  • Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Admission Application

  • Date of Birth: *
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Citizen Status
  • Preferred Time:*
  • Education History

  • Graduation Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Graduation Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • The information requested below is for statistical purposes only. Your response has no impact on your admission to any program of study.

  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • High School Diploma and Transcript Request Form

  • 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 office (Please see Information Below)

  • Student Information

  • Format: (000) 000-0000.
  • Date of Birth:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • School Information

  • Graduation Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • High School Graduation/ Foreign High School/GED/ Certification Form

  • Student Information

  • High School Last Attended

  • Graduation Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Did you graduate from High School?
  • Did you receive your High School credential in a foreign country?
  • Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • Did you receive your High School credential in a foreign country?
  • Did you receive your GED?
  • Date:
     / /
    2 digit month, 2 digit day, 4 digit year
  • 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.

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Emergency Medical Statement

  • Student Information

  • Emergency Information

    In case of emergency, whom should we contact?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Have you ever had or do you have?
  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • Students Disclosures

  • 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: 91.00%

    *Placement Rate: 73.00%

    *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

  • Date:*
     / /
    2 digit month, 2 digit day, 4 digit year
  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • 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's 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 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

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  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • I, * Certify that I received a copy of the Admissions presentation/ school catalog and understand all the material presented to me upon enrollment.

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  • CDE Career Institute

    Phlebotomy Application

    Complete the form below.
  • 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.
  • Initials

  •   *    School Catalog

  •   *   School's Completion/ Graduation Rate

  •   *   School's Job Placement Rate

  •   *   Copy of completed Enrollment Agreement

  •   *   Satisfactory Academic Progress Policy

  •   *   Gainful Employment Disclosures

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