Signed Student Responsibilities Form

HISTOTECHNOLOGY PROGRAM
PARTICIPANT RESPONSIBILITIES
Please complete both Student and Lab Responibility Forms
STUDENT RESPONSIBILITIES 2015-2016:
1.
The student will be registered for classes on the Indiana University-Purdue University at Indianapolis (IUPUI)
campus. The student will be registered for 12.0 credit hours for the Fall and Spring terms and billed separately for
each term. We estimate tuition/fees for each semester to closely follow charges incurred during
2014-2015. The student should expect a bill for each semester in the range or $2,750 for Histotechnology fees plus an
approximate $490 general service fee charged by the campus. Students are registered for the first four courses (2 lectures, 2
practical) during their first semester. The last four courses (2 lectures, 2 practical) are taken the during the second semester.
Students who have not paid their first semester fees will not be allowed to start second semester classes until their account is paid
in full. A late fee is applied on a monthly basis for those who do not make full payment but the stated due date (typically the
third Tuesday in September for fall starts and the third Tuesday in January for spring starts).
For more information on methods of payment, please visit
http://bursar.iupui.edu/payment_options.htm. The IUPUI campus does not mail a paper bill to the student’s home address,
instead it uses an electronically delivery via QuikPay (http://bursar.iupui.edu/QuikPay.htm) to the student’s IUPUI email
address.
2.
The student will attend weekly 1-hour web conference (internet based) scheduled on Wednesdays near midday. The
certificate program’s curriculum is 40 weeks long.
NOTE: Enrollment in this program assumes computer proficiency in at least but not limited to the following areas: web
browsing, email, and file attachments.
3.
The student will complete and submit required work in both the didactic courses Path-H101, 102, 103 and 104) and
practicum courses (H181, 182, 183 and 184), which will consist of written work and technical products such as blocks
and /or slides and pledges of independent completion of technical tasks and exams. ______________ (Initial)
4.
It is recommended that student will take the American Society of Clinical Pathologists (ASCP) Histologic Technician or
Histotechnologist exam within six months after completion of the Program’s curriculum. ______________ (Initial)
Both the laboratory, clinical education supervisor, and the student will comply with rules of the Program, as it is administered
through the Indiana University School of Medicine. ______________ (Initial)
NOTE TO STUDENT: Self-discipline is an essential component of the mastery of the four didactic courses as well
as the practical courses. No one else can do the work for you; it is your goal and commitment to the task that insures
successful completion of the courses. Proficiency in written and verbal English is also assumed. By university policy,
applicants with an international background must provide proof of English proficiency when completing requirements to
be admitted to Indiana University.
My initials and signature indicate that I have read and understood my responsibilities as a student, and I will fulfill my duties and
responsibilities.
STUDENT SIGNATURE:___________________________________ DATE: _________
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