National College of Midwifery Brilliance Contract Revised10/2016 Page 1 of 3

Brilliance Path Contractbetween Student & the National College of Midwifery

Program Information:Program Name: Associate of Science in Midwifery 112.88 credits (116.88 credits for California) plus optional BSM Bridge

Date of Curriculum being used:______01/2015____ Date of NCM Student Handbook Catalog being used: ____2016___ __

Student Information:

Name of Student:______Date of Birth:______

Student Address: ______City: ______State: ______Zip Code: ______

Country: ______Phone______Email______

Preceptor Information:

Name of Preceptor: ______Date of Birth:______

Preceptor Address: ______City: ______State: ______Zip Code: ____

Country:______Phone______Email______

Dates of Student study with this Preceptor: From (MM/DD/YY):______To (MM/DD/YY):______/ Preceptor Initials / Student Initials
The Student and Preceptor have discussed the time commitment necessary to complete the program. Student and Preceptor have reviewed the Sample Course of Study, and have completed their own Plan of Completionfor all academic and clinical requirements.
Student and Preceptor Acknowledgements:
I have received NCM’s Handbook/Catalog and Contract. These items constitute the entire agreement between the student, preceptor & NCM,are available onlineboth before and during a student’s enrollment at NCM, and are subject to periodic change.
I understand that NCM does not guarantee the transferability of credits to a college, university or institution. Any decision on the comparability, appropriateness and applicability of credit and whether they should be accepted is the decision of the receiving institution.
I understand that NCM does not have a job placement program and does not guarantee job placement to graduates upon program completion or upon graduation.
I understand that NCM does not guarantee midwifery licensure following graduation. Prior to enrollment, students must contact the appropriate state regulatory agency to determine if the NCM program will satisfy its requirements. I have been provided by NCM with the contact information for my state’s regulatory agency.
I understand that NCM may terminate the student’s enrollment for failure to abide by established standards of conduct, to maintain satisfactory academic progress, and to comply with attendance, academic, and financial requirementsin the Catalog. The student's financial obligation to NCM must be paid in full before a certificate/degree may be awarded.
I understand that should the student and preceptor terminate their contract, the student is still enrolled in the College and may continue training with different preceptor(s) under separate contract(s).
I understand that recent and potential trends on the part of the United States Department of Education, the North American Registry of Midwives and the Midwifery Education Accreditation Council have been towards greater scrutiny and regulation around students obtaining clinical experience outside of the United States. Changes to policies have been known to happen with minimal warning to the National College of Midwifery, its preceptors and students which have resulted in increased costs and abrupt changes in the course of study for students who were studying abroad. In the case that such changes should occur during my time studying abroad, I understand that it will be my responsibility to seek alternative routes to completing my studies. Should I choose to withdraw from NCM under this circumstance, I understand that I will still be held to the refund policy set forth by the National College of Midwifery.
Brilliance Path students are initially enrolled in ASM program and must finish this program before being enrolled in BSM program.
Brilliance Path students must complete the BSM program within 24 months of their ASM graduation.
Brilliance Path students pay continuous and uninterrupted annual fees beyond 2 years of enrollment at NCM until graduation.
Administrative fee is applied in full to the ASM program with the BSM program offered at no charge as part of the Brilliance Path. There will be no refunds for students who choose to not complete the BSM program.

REQUIRED CLINICALS: The student will not be enrolled until she/he has contracts accounting for all required clinical experiences. Enrollment in and completion of the ASM program requires at least two clinical preceptors with contracts accounting for all required clinical experiences.

Preceptor must write-in & initial the number of required clinicals she/he plans to supervise during the dates of study: / Clinical #s: / Preceptor Initials / Student Initials
10 Births as an Observer / 
25 Prenatals Exams as Assistant (including 3 Initial Prenatals) / of 25
20 Births as Assistant (At least 18 of the 20 Births as Assistant completed prior to starting Births as Primary) / of 20
20 Newborn Exams as Assistant / of 20
10 Postpartum Exams as Assistant / of 10
30 Well Woman/Family Planning as Primary Under Supervision / of 30
20 Initial Prenatals as Primary Under Supervision / of 20
55 Prenatals as Primary Under Supervision / of 55
25 Births as Primary Under Supervision / of 25
20 Newborn Exams as Primary Under Supervision / of 20
40 Postpartum Exams as Primary Under Supervision / of 40
5 Continuity of Care / of 5
10 Out of Hospital Births / of 10
4 NARM Skills: Initial Prenatal, Prenatal, Newborn Exam, Postpartum Exam / of 4

STUDENT-PRECEPTOR REMUNERATION AGREEMENT:

This Remuneration Agreement is between one student and one preceptor - continue below:

Payment Agreement is with group practice or learning site- please do not fill-out here, but instead attach a Fee Statement for Learning Site.

Discretionary Units / Student-Preceptor Remunerations / Method for Acknowledging Exchange
(Subject to Remuneration Refund policy)

Discretionary Units

Discretionary Units refer to a length of time (weeks, months, trimester) or activity (such as births, classes, correction of modules, defined tasks, etc.) Please note that NCM does not accept any time unit longer than a trimester. The Discretionary Unit and Remuneration associated with it is recurring through the contract length. A new Preceptor Fee Agreement can be submitted at the end of any Discretionary Unit.

Remuneration is exchanged between student and preceptor only. Remuneration can be delineated in a myriad of ways, including but not limited to an exchange of personal and professional services, office work, payment by student to preceptor, or even preceptor remuneration to the advanced student for birth assistant services when appropriate.

Remuneration is defined by Discretionary Units and includes specifics, such as type of work, dollar amounts, and acknowledgement of completion (for example a time sheet, receipt, etc.). If the remuneration is not a monetary amount there still must be a monetary amount associated with the remuneration. (e.g. 5 hours of office work @ $15/hr).

  • Preceptor agrees to note the student’s name or initials on all client charts for supervised clinical experiences, and to make these charts available for review, in case of audit, and as required for student certification and licensure.
  • Preceptors are required to file (as appropriate) on all income earned from students in NCM programs with the IRS and State Taxation Department.

Student-Preceptor Remuneration Agreement Cancellation and Refund Policy

  • Either party may terminate this arrangement if a working relationship fails to develop or if remuneration agreements are not met according to this contract. Should the agreement be terminated prior to completion of the Remuneration Agreement timeframe, the monetary amount of the remuneration will be exchanged.
  • The preceptors will notify NCM of any changes in writing within 30 days.
  • Students and preceptors enter into their own financial agreements. Remunerations are exchanged and if a refund ever becomes necessary is directly between preceptor and student.
  • The student must submit a written termination of contract and request for refund to the Preceptor in writing in person or by mail.
  • Refunds must be made within 30 calendar days after receiving written notice of a student's withdrawal or termination of enrollment of the student.
  • The student and preceptor agree to the following refund schedule:

Date of student withdrawal as a % of the enrollment period (Discretionary Unit) for which the student was obligated / Portion of tuition and fees obligated and paid eligible to be retained by the Preceptor
Cooling off period of at least three work days from the date of agreement or payment / All payments shall be refunded
Prior to commencing instruction of the Discretionary Unit / No more than $100 or 5% in tuition or fees, whichever is less, may be retained by the Learning Site as registration charges
On 1stclass day of the Discretionary Unit / 0%
After 1stday; within 10% of the Discretionary Unit / 10%
After 10%; within 25% of the Discretionary Unit / 50%
After 25%; within 50% of the Discretionary Unit / 75%
50% or thereafter the Discretionary Unit / 100%

Updated 12/14/15 to satisfy U.S. department of education and NM POST-SECONDARY EDUCATIONAL INSTITUTION ACT 5.100.2.20

Example Remuneration Agreements between student and preceptor:

Examples / Discretionary Units / Example Student-Preceptor Remunerations / Method for acknowledging exchange
Example 1 / per month / $200 paid by student to preceptor in exchange for an invitation to all appointments and births plus 5 hours of preceptor time outside of these clinical activities / Monthly receipt
Example 2 / per week / 5 hours office work done by student @ a rate of $15/hour= $75 in exchange for an invitation to all appointments births / Time sheet
Example 3 / per birth / $100 paid by preceptor to advanced level student in exchange for assisting at specific births / Monthly receipt
Example 4 / per credit / $60 paid by student to preceptor in exchange for correction of learning objectives / Monthly receipt
Example 5 / per hour / $20 paid by student to preceptor for academic instruction / Receipt at time of service
Example 6 / per month / $0 paid by student to preceptor for academic & clinical instruction / none
Preceptor Initials: / Date: / Student Initials: / Date:

CHARGES, FEES & REQUIRED PURCHASES:

Payments made to the National College of Midwifery are not tax deductibleand NCM does not issue 1098T forms.

PAID TO THE NATIONAL COLLEGE OF MIDWIFERY:

  • Application Fee (prior to enrollment): $100 is non-refundable
  • Cost of 2 year ASM Program: $9000
  • Yearly Extension Rate beyond 2 years: $1500 (up to 3 extensions for ASM, plus 2 extensions for BSM bridge)
  • Payment Plan option for ASM program Fee: $4,500 paid upon enrollment, plus monthly payments of $375 for 12 months.

ADDITIONAL ESTIMATED COSTS NOT PAID TO THE NATIONAL COLLEGE OF MIDWIFERY:

TEXTBOOKS:Students are not required to own the books, but must have access to them. NCM does not sell books, and the books required for courses are not included in NCM’s administrative fee.

Estimated Cost:$2300 (used) $3000 (new).

MIDWIFERY EQUIPMENT:Students are not required to own midwifery equipment, but must have access to it through their preceptors. Some preceptors may require that students possess some or all of their own midwifery equipment. Costs of equipment vary.

REQUIRED CERTIFICATIONS AND OTHER COURSES TAKEN OUTSIDE OF NCM: Students are required to be certified in CPR & NRP. Math, English and other academic courses taken outside of NCM: The costs for these are the responsibility of the student, and are variable.

OUTSIDE EXAMINATION:

  • NARM EXAM OR OTHER OUTSIDE EXAM FEES: Paid directly to testing organization when applying to test. Fee subject to change. Please contact your testing organization directly for the current fees.
  • ACCOMMODATION & TRAVEL TO TEST SITE: Varies depending on location and distance.

REMUNERATION/Tuition: Preceptors may require remuneration for their academic and clinical teaching time in the form of a monetary or service amount. Students and their preceptors agree to remuneration per discretionary unit detailed in the Remuneration Agreement in this contract. Remuneration (if any) is subject to the NCM’s Refund Policy. All refunds are handled directly between preceptors and student.

LEARNING SITE FEE: Some preceptors may work in a clinic, practice, or other learning site that requires a Site Fee. This fee is paid directly by the student to the Site. Students are required to complete a Fee Statement for Learning Site Form and submit it to the College.

CANCELLATION AND REFUND OF NCM TUITION AND FEES:
For the Administrative Fee, NCM considers the start date to be the date the student is notified by NCM that they are officially enrolled in their program.No refund of administrative fee for graduated students who graduate early due to advanced standing
Refunds are calculated based on 352 day year. Tuition/fee refunds must be made within 30 calendar days of the institution receiving written notice of a student's withdrawal or of the institution terminating enrollment of the student, whichever is earlier.
Upon request by a student or the department, the institution shall provide an accounting for such amounts retained under this standard within five workdays.
NCM will honor state-mandated refund policies for higher education of the student’s state of residence, if more generous than NCM’s stated refund policy.
2 year ASM Program (Brilliance path) : $9000
2 Year Program Refund Policy:
Refund 100% ($9,000) day 0 - 3 (business days)
Refund 90% ($8,100) days 4 - 71
Refund 50% ($4,500) days 72 - 176
Refund 25% ($2,250) days 177 - 1 year anniversary date of enrollment
Refund 0% after 1 year anniversary date of enrollment
/ Yearly Extension Rate beyond 2 years: $1500
Yearly Extension Rate Refund Policy:
Refund 100% ($450) day 0 - 3 (business days)
Refund 90% ($405) days 4 - 36
Refund 50% ($225) days 37 - 88
Refund 25% ($112.50) days 89 - 176
Refund 0% after 176 days of 1 year extension

(Revised 8/2016 to conform to NM Commission of Higher Education rule 20.D)

CONTRACT ACCEPTANCE

My signature below signifies that I have read and understand all aspects of this agreement and recognize my legal responsibilities in regard to this contract.

Signature of Student / Date
Signature of Preceptor / Date
Signature of NCM Official (Date of signature of NCM official is the official date of enrollment) / Date

National College of Midwifery, 1041 Reed St, Suite C, Taos, NM 87571

Preceptor references and official transcripts may be sent separately. Incomplete applications are discarded after 60 days.