Student MLS Agreement

STUDENT MLS PROGRAM AGREEMENT

This Student MLS Program Agreement (Agreement) is entered into by and between Student Name: and Institution Name: , on behalf of the Medical Laboratory Science (MLS) Program. The parties agree to the terms set forth below effective as of Program Start Date: .

Student Information

Program and Enrollment

Program Title: Expected Completion Date:

Tuition, Fees, and Payment

Total Program Tuition and Fees: $ Payment Plan Selected:

Student acknowledges responsibility for tuition, fees, and any clinical placement costs. Failure to satisfy financial obligations may result in suspension from clinical assignments and withholding of transcripts or certificate of completion until obligations are met.

Clinical Placements, Background Checks, and Health Requirements

Student understands and agrees that participation in MLS clinical experiences requires assignment to off-campus clinical partner sites. Clinical placement is contingent upon satisfactory completion of background checks, drug screening, immunizations, and any site-specific onboarding requirements.

I consent to a criminal background check as required by clinical partners.

I agree to submit to drug screening per program and clinical site policies, and I understand that a positive result may preclude participation in clinical rotations and may result in dismissal from the program.

Confidentiality, HIPAA, and Release of Records

Student acknowledges duty to maintain patient confidentiality and to comply with all applicable privacy laws and clinical site policies, including the Health Insurance Portability and Accountability Act (HIPAA). Unauthorized disclosure of patient information or clinical records is grounds for immediate disciplinary action, up to and including dismissal.

Student authorizes the release of academic and health records to clinical placement sites as necessary for site placement and compliance with site requirements. Student further consents to disclosure of limited educational records to third-party certifying agencies for the purpose of licensure or certification eligibility.

Code of Conduct, Attendance, and Academic Standards

Student agrees to abide by the program's Code of Professional Conduct. This includes obligations of professional demeanor, punctuality, compliance with dress code, and completion of assigned coursework and competencies. Excessive absenteeism, academic dishonesty, unsafe laboratory practices, or unprofessional behavior may result in remediation, suspension, or dismissal.

Liability, Insurance, and Indemnification

Student understands that the Institution maintains professional liability coverage for program activities where required, but Student is responsible for personal health insurance and personal property. Student agrees to indemnify and hold harmless the Institution and clinical partners from claims arising from Student's negligent or intentional acts, except where liability is imposed by law on the Institution or clinical partner.

Withdrawal, Dismissal, and Appeals

Withdrawal from the program must be submitted in writing to the program director. The program reserves the right to dismiss a student for violations of program policy, failure to meet academic standards, or inability to participate in clinical assignments. Students may appeal dismissal decisions pursuant to the Institution's published grievance procedure.

Student Acknowledgements and Certifications

By signing below, Student certifies that all information provided to the program is true and complete. Student acknowledges receipt of the program handbook and policy documents, and agrees to comply with all program and clinical site rules. Student understands that completion of the MLS program does not guarantee eligibility for certification or licensure if statutory or regulatory conditions are unmet.

Emergency Contact Name: Phone:

If Student is under the age of majority, Parent/Guardian must complete the following:

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