University Handbook, DPT Program Student Handbook, DPT Clinical Education

Handbook, and Honor Code Acknowledgement

By signing below, I, , agree that I have received,

read, and understand all information contained in the Rocky Mountain University of Health
Professions University Handbook, the DPT Program Student Handbook and the DPT Program
Clinical Education Handbook. I also agree that I will adhere to and abide by the rules and
regulations contained therein, which include, but are not limited to, the University Honor Code
and code of conduct. I am aware of the consequences of violations of specific policies and
standards, including plagiarism and dishonesty.

Signature Date

Printed Name Program and Year

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 DPT Program Release, Informed Consent and Waiver

I, , am a student at Rocky Mountain University of Health

Professions, Inc. (the “University”). I will be enrolled in courses that will include the teaching of laboratory
activities and interventions, including hands-on techniques (the “lab activities”). I understand that
participation in the lab activities is an important part of the education offered in the RMUoHP DPT program
and that my participation is generally expected except in the case where medical or other extenuating
circumstances might temporarily excuse such participation. Any exceptions must be approved by the
instructor or Program Director in writing and I am still responsible for mastering all required skills and
knowledge. In participating, I agree to obtain and provide informed consent for all lab activities.

I hereby release the University and all of its shareholders, directors, trustees, officers, employees,
representatives and faculty members (the “Released Parties”) from all liability for any harm, injury or illness
of any kind that I may incur as a result of my participation in the lab activities (any “Harm”).

If I participate in the lab activities, by so doing I will represent and agree that:

(1) I have no pre-existing condition that would make my participation harmful to me in any
manner and will disclose any such conditions;
(2) I have had the opportunity to discuss my participation and this Release with competent
medical and legal advisors;
(3) I RELEASE and DISCHARGE all Released Parties (except anyone who intentionally causes
Harm) from all liability for any Harm;
(4) I WAIVE ALL CLAIMS AGAINST and COVENANT NOT TO SUE the Released Parties (except
anyone who intentionally causes Harm) for any Harm;
(5) I ASSUME FULL RESPONSIBILITY FOR ANY HARM, INCLUDING ANY RISK OF BODILY
INJURY, ILLNESS OR DEATH arising out of or relating in any way such participation; and
(6) The Released Parties shall have NO DUTY TO WARN me of any risks at any time.

I understand that the University provides DPT students with professional liability insurance that is only
available for incidents occurring while enrolled as an RMU DPT student engaged in approved educational
activities, including clinical education. However, I agree that I take full responsibility for my own health and
well-being and accept responsibility for any injury or illness incurred in the educational process.
Therefore, I shall maintain my own health insurance acceptable to the University, with a minimum of Major
Medical coverage. I shall also provide the University with satisfactory evidence of the existence of such
insurance at all times, including satisfactory evidence of its renewal or replacement before its expiration or
cancellation. I further agree to hold harmless and indemnify the University, and its owners, directors,
officers and employees, from and against all losses, claims, damages and expenses, including reasonable
attorneys' fees and court costs, arising out of or relating to my actual or alleged professional negligence or
misconduct.

This Release and Waiver is intended to be as broad and inclusive as is permitted by law, and if any portion
is held invalid, the balance shall continue in full force and effect.

Student Signature: Date:

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 DPT Program Disclosure Form
The purpose of the form is to review certain facts described during the admissions process in an effort to
prevent any misunderstanding by our students. Please read the following information regarding your
education process and sign your initials at the end of each paragraph to indicate your understanding of and
agreement to each item. When you have finished reading the entire form, please sign your name in the
space provided at the bottom.

HOUSING AND JOBS WHILE ATTENDING RMUoHP: Although employment from local businesses and
housing in the immediate area of the University may be available, the University has not guaranteed me
employment or housing. Because of the demands of full time professional education in general, and the
DPT program specifically, it is recommended that students do not plan to work full time during the didactic
portion of the program, and not at all during clinical affiliations.

FINANCIAL ASSISTANCE: As with any university, student loans and/or grants are made available
depending upon the financial information provided by the applicant. The University has not guaranteed that
I will receive a loan or a grant. If I receive a loan, I understand that I will be responsible for repaying the
loan.

HEALTH INSURANCE: I understand that I must have health insurance while enrolled as a student in the
DPT program and must provide proof of insurance. I understand that I am responsible for all associated
costs. Failure to show proof of insurance may result in disciplinary action up to and including dismissal from
the program.

UNIVERSITY HANDBOOK: In addition to DPT program student and clinical handbooks, I understand that
the University Handbook has terms and conditions regarding my education. The University Handbook is
available through the www.rm.edu website. I agree to read the all handbooks and agree to abide by the
contents.

ATTENDANCE: The University requires daily attendance as an important part of your training program.
Students failing to maintain satisfactory attendance requirements for their courses are subject to
administrative actions, which may include probation, suspension from school, or denial of graduation. The
attendance policy is contained in the University Handbook.

APTA MEMBERSHIP REQUIREMENT: I understand that I must obtain student membership in the APTA
and maintain this membership while enrolled as a student in the DPT program. I understand that I am
responsible for all associated costs and that failing to comply could lead to disciplinary action up to and
including dismissal from the program.

CRIMINAL BACKGROUND CHECK AND DRUG TESTING: I am aware that I will be required to undergo
a criminal background check and possibly drug screening prior to be being allowed to participate in clinical
rotations. I understand that a record of criminal behavior may preclude me from being able to participate
in clinical education at most if not all facilities and may prevent me from being employed. I understand that
should I be prohibited from attending a clinical rotation at a clinical facility due to findings on my drug
screening or criminal background check, I may be dismissed from the Program.

CLINICAL EDUCATION REQUIREMENTS: Clinical rotations and internships are an integral part of the
curriculum and may require that a student temporarily relocate. I understand that I may, and most likely
will, have to leave the local area, or the State, for any or all clinical affiliations. I am aware that I am
responsible for the cost of the travel and other related expenses.

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Students will be required to meet all requirements outlined in the Clinical Education Handbook on
“Immunizations, Certifications, and Related Requirements” by required deadlines. Failure to comply with
these requirements can lead to dismissal from the program.

COMPUTER REQUIREMENTS: All students will be expected to have reliable laptop computers with
hardware and current software that meet the University Technology requirements noted in the University
Handbook and available on the Website.

EMPLOYMENT: Enrollment in and successful completion of the DPT program does not guarantee that a
student will pass the national licensure exam, nor does the school guarantee that a student will get a job or
obtain employment.

CORE PERFORMANCE STANDARDS: Core Performance Standards are divided into two parts;
Technical Standards and Professional Behaviors. As part of the application process applicants will be
required to review the Technical Standards required for the program, and self-report if any questions exist
regarding ability to meet these standards. Students will be introduced to the Professional Behaviors in their
first semester. The Core Performance Standards are available for review on the RMUoHP web site.

The entry-level Doctor of Physical Therapy Program at Rocky Mountain University of Health Professions is accredited by the
Commission on Accreditation in Physical Therapy Education (CAPTE), 3030 Potomac Ave., Suite 100, Alexandria, Virginia 22305-
3085; telephone: 703-706-3245; email: [email protected]; website: http://www.capteonline.org. If needing to contact the
program/institution directly, please call 801-375-5125 or email [email protected].

By signing my name in the space provided below, I verify that I have read, fully understand, and agree, and
will comply with the statements contained in this disclosure form.

Student Signature: Date:

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 DPT Program

Health Insurance Statement

The practice of physical therapy may have certain occupational risks. Students are required to
carry their own health insurance and sign a waiver assuming all financial responsibility for any
illness or medical bills occurred while enrolled in RMUoHP DPT Program. RMUoHP assumes no
financial responsibility for an ill student, and all medical bills are the student’s responsibility.

Please complete the following information:

I have read the health insurance statement above. I am presently insured.

I declare to the best of my knowledge that I do not have and/or have not been exposed to any
serious communicable diseases.

I understand that my status at RMUoHP will change if I do not tell my Program Director of any
medical condition that my affect my school, other students, faculty, and staff members.

I understand that I assume all liability for any injury caused while performing laboratory or
technical skills.

I understand that the performance of these procedures is required in order to graduate from this
program.

I understand that any information discussed with the Program Director will be held in confidence,
but that the Program Director reserves the right to discuss my needs and personal information
with appropriate personnel including other faculty and administrators

Student Name (please print):

Signature:

Name of Health Insurance Company:

Insurance Phone #:

Policy #:

Date:

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 DPT Program

Multimedia Consent/Release Form

I do hereby consent to be photographed and/or videotaped, and have my voice and image
recorded or otherwise by students, staff, or faculty of RMUoHP.

I understand that these recordings will be utilized for educational purposes only and as such
will not be made available for public viewing.

This authorization extends from

to (Indefinitely, if not otherwise stated).

Name (please print):

Signature: Date:

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