Home Health Aide

Home Health Aide

FLEX Program Application for Kiamichi Tech, Spiro Campus | 610 SW 3rd St. Spiro, OK 74959
Dear Prospective Student:

Kiamichi Tech – Poteau and Spiro campus offers Home Health Aide certification course for individuals seeking the HHA deeming-certification through the Oklahoma State Department of Health - Nurse Aide Registry. Students may complete this training through our FLEX program offered at the Spiro campus. Students must be at least 16 years old to enroll. For more information, please contact the Workforce & Economic Development Center.

Course Tuition:
- Tuition $100.00
- Book Fee $29.00
- Testing Fee $15.00
- Supplies $12.00
- Fees $4.00
Total $160.00

Total payment for the course or a funding letter AND a completed registration packet is required to complete enrollment.

The following records are REQUIRED when enrolling for class:
- Driver’s License or Photo ID
Students are required to wear plain navy blue scrubs and closed-toe shoes for class and clinical days. Students must provide his/her own transportation to and from class and to the clinical site. If you have any questions or to enroll, please call the Workforce & Economic Development Center at 918-647-4525.

Sincerely,

Shannen Hamby
Workforce & Economic Development Coordinator

* Please note: If students choose to receive a refund prior to the class starts, students will not be refunded the $12 fee for the Canvas LMS.

Possible Funding Sources for Short-Term Programs:

Chickasaw Nation Higher Education: Darius Roebuck (580)421-7711

Choctaw Nation Career Development: Leflore/Latimer Counties: Cynthia Martin (918)448-7508 or David Billy (918)448-4808

Haskell/Hughes/Macintosh Counties: Jane Buffington (918)967-9085

Choctaw Nation resources for other tribes: WIOA (Reimbursement Program only), Voc. Rehab, Vocational Development Ginger Crawford (800)522-6170

Cherokee Nation Career Services: Jennifer Davis (918)776-0416

Oklahoma Workforce: Leflore County - Tara Tate or Jennifer Walker (918)647-5599; Latimer & Haskell Counties - (580) 559-1780

Vocational Rehabilitation: Lisa Smith (918) 647-8121
Personal Information
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Who is paying your tuition for this course?
If you are receiving third-party funding, please list the entity below:
Are you 18 years old or older?
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Repeat Customer: Have you taken a course with Kiamichi Tech in the past 2 years?
Do you consider yourself a person with a disability?
If you answered yes, please list the accommodations you are requesting to support your education throughout the training and testing phases; please note you MUST request accommodations prior to training if you will need them:
Have you ever entered a plea of Guilty or Nolo Contendere to, or been convicted of, a state (any state) or federal felony offense?
Several occupations require certification or licensure which may be denied if a felony record exists. In addition, certain licensure boards require submission of a Social Security Number before training can begin. No person seeking admission will be unilaterally excluded solely on the basis of a felony conviction, but those with felony convictions are subject to administrative review. If this is a concern, please discuss your questions with your career advisor or technology center representative.
BY SIGNING BELOW, I UNDERSTAND IT IS KIAMICHI TECH’S POLICY THAT STUDENTS ARE NOT ELIGIBLE FOR A TUITION REFUND AFTER THEY ATTEND 1 HOUR OF TRAINING.

• BY SIGNING BELOW, I UNDERSTAND IF I DO NOT SHOW UP FOR MY TRAINING I FORFEIT THE COURSE FEE.

• BY SIGNING BELOW, I GRANT KIAMICHI TECH THE ABSOLUTE RIGHT AND PERMISSION TO PUBLISH PHOTOGRAPHIC PICTURES OR VIDEOS OF ME, IN WHICH I MAY BE INCLUDED IN WHOLE OR PART, IN ADVERTISING, PROMOTIONAL, OR OTHER LAWFUL PURPOSES WHATSOEVER.
Signature
Emergency Contact Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to the Student
Student Signature
Date

MonthDayYear
Date
Attendance Policy for FLEX Helathcare Programs
The Oklahoma State Department of Health requires students to complete 16 hours
of professional training in order to obtain Home Health Aide certification.

Attendance in this training program is mandatory. While this training program is

Students are expected to communicate with the LTCNA Instructor if they are
unable to adhere to the set class schedule, or with any changes and
emergencies.
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Please take time to review the Kiamichi Tech Workforce & Economic Development Student Handbook.
Please check ALL statements in this section to verify you have read and understand Kiamichi Tech's healthcare handbook student expectations. Please reach each box carefully! This will become part of your education record.

I have read and understand the Drug/Alcohol screening policy. I understand that somefacilities will require a drug/alcohol screening test. I authorize that the results of the alcohol/drugscreening test be given to officials at Kiamichi Tech for review of continuous enrollment in healthcareer programs. I also release and hold harmless Kiamichi Tech, its Board of Education,superintendent, management, instructors, or any other agent or employee for the use of anyinformation received as a result of the screening process.I understand and acknowledge, and I hereby give Kiamichi Tech the absolute right and permission to publish photographic pictures of me, in which I may be included in whole or in part, in advertising, promotional or other lawful purposes whatsoever. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, or the use to which it may be applied.I understand by signing this document, my records including grades, transcripts,suspicions of drug/alcohol use, any counseling statements, time spent in the program, historywithin my program, progress and attitude may be discussed with employers, or other schoolpersonnel that are appropriate. I understand that I am on my own medical insurance while inthe class/lab/or clinical site. I will self-disclose to Kiamichi Tech any arrest, conviction, or chargesfiled against me while enrolled in this course. Kiamichi Tech reserves the right to deny a studentadmission to any health career program if the student refuses to sign this statement ofunderstanding.
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Kiamichi Tech Academic Integrity Policy

Kiamichi Technology Center is committed to fostering a culture of academic excellence and integrity. As students enrolled in our short-term training programs you are expected to uphold the highest standards of honesty and ethical behavior. This policy outlines the expectations and responsibilities regarding academic integrity.

1. Honesty and Integrity

Cheating: Any form of cheating, incluing copying assignments, using unauthorized materials during exams, or collaborating with others on individual assignments, is strictly prohibited.
Plagiarism: Presenting someone else's work or ideas as your own, without proper attribution, is a serious violation of academic integrity.
Fabrication: Falsifying or inventing any information, data, or citations in academic work is unacceptable.

2. Use of Technology

Artificial Intelligence: The use of AI tools or software to complete assignments, exams, or any academic work is prohibited unless explicitly allowed by the instructor.
Digital Ethics: Students must not take pictures of any curriculum materials, exams, or assignments, nor share coursework with anyone outside the program.

3. Confidentiality

Course Materials: All course materials, including lectures, handouts, and assignments, are confidential and should not be shared or distributed without permission.
Patient Information: Any patient information encountered during clinical practice must be kept confidential and handled in accordance with HIPAA regulations.

4. Reporting Violations

Responsibility: Students are encouraged to report any suspected violations of academic integrity to the instructor or program coordinator.
Consequences: Violations of this policy may result in disciplinary actions, including but not limited to, failing grades, suspension, or expulsion from the program.

5. Commitment to Excellence

Professionalism: Students are expected to always conduct themselves professionally and ethically, both in academic settings and clinical practice.
Continuous Improvement: Strive for continuous improvement and excellence in your academic and professional endeavors.

By adhering to this policy, students will contribute to a learning environment that values integrity, respect, and academic excellence. Thank you for your commitment to upholding these standards as a Kiamichi Tech student.
By signing below, I understand the Kiamichi Tech Academic Integrity policy and agree to adhere to the policy throughout my training and coursework.
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Home Health Aide

Personal Information

Emergency Contact Information

Attendance Policy for FLEX Helathcare Programs