AFFIDAVIT OF LAWFUL PRESENCE BY PERSON MAKING APPLICATION FOR A LICENSE, PERMIT, OR CERTIFICATE I, the undersigned applicant, being of lawful age, state that one of the following statements is true and correct (check which of the following statements apply): I state under penalty of perjury under the laws of Oklahoma that the foregoing is true and correct and that I have read and understand this form and executed it in my own hand. Qualified Aliens: State law requires the Oklahoma State Department of Health to verify the immigration status (lawful presence) of all non-U.S. citizens upon initial license/certification and renewal. Qualified aliens must attach a copy (front and back) of the documents that support their status as shown above with their Affidavit of Lawful Presence. A license, permit, or certification will not be issued until the appropriate documentation is submitted.

As a student enrolled in the Certified Nursing Assistant (CNA) program, your education and safety, as well as the safety of patients, are of utmost importance. Therefore, students are only permitted to perform tasks and procedures at clinical sites that have been explicitly taught and practiced during classroom and lab training at Glory Nursing CNA School. Important Guidelines 1. No Unapproved Tasks: Under no circumstances should you attempt or perform any clinical task or procedure that has not been covered in your coursework. This includes tasks that you may observe staff or other healthcare professionals performing. If you are asked to perform such tasks, respectfully inform the staff that it is outside your current scope of training. 2. Supervised Tasks: All tasks performed at the clinical site must be done under the supervision of a qualified preceptor. This ensures both the correct application of skills and adherence to patient safety standards. 3. Ask for Clarification: If you are ever unsure whether a task is within your scope of training, do not hesitate to ask your clinical instructor for clarification. It is better to seek confirmation than to risk patient safety or your own performance. 4. Student Responsibility: Students are expected to always demonstrate professionalism and ethical responsibility. Engaging in unauthorized tasks could result in disciplinary action and may impact your standing in the program. Consequences of Non-Compliance Any student found performing unauthorized tasks will be subject to the following disciplinary actions: - Immediate suspension from the clinical site - Review of the incident by school administration - Possible removal from the CNA program Commitment to Safety and Learning The clinical experience is designed to complement your education and provide a safe learning environment for practical application. Adhering to the tasks you have been taught ensures that you develop skills progressively and in a manner that protects the well-being of all involved. Please remember that patient safety, as well as your professional integrity, depend on your adherence to these guidelines. Acknowledgment of Policy: By signing below, you acknowledge that you understand and agree to follow the guidelines outlined in this document.

As a student at Glory Nursing CNA School, I understand that photographs, videos, and other forms of media may be taken during my time at the school for educational, promotional, and marketing purposes. These images may be used in various formats including, but not limited to: - Websites and social media platforms (e.g., Facebook, Instagram) - Print and digital advertising materials - Newsletters, brochures, and other promotional materials - Training materials and educational presentations I Consent: I, the undersigned, grant permission to Glory Nursing CNA School to use photographs, video recordings, and/or other media that may include my image, voice, or likeness for the purposes outlined above. I understand that these images may be used without compensation and will remain the property of Glory Nursing CNA School. I Decline: I, the undersigned, do not grant permission to Glory Nursing CNA School to use photographs, video recordings, and/or other media that may include my image, voice, or likeness. I understand that if I decline, every effort will be made to exclude me from media content, and my decision will not affect my participation in school activities. I understand that: 1. My participation is voluntary, and I may revoke or modify this consent at any time by providing written notice to the school. 2. My personal information (e.g., name, contact details) will not be disclosed in the use of such materials unless explicitly permitted by me.

All students enrolled in the Certified Nursing Assistant (CNA) program at Glory Nursing CNA School are required to undergo a criminal background check before participating in clinical training or graduating from the program. This background check is mandated to ensure compliance with healthcare facility policies and state regulations. By signing this waiver, you acknowledge and agree to the following: 1. Clean Background Requirement: In order to qualify for clinical placement and graduation, students must pass a criminal background check per state and facility requirements. Please let Glory Nursing management know if you would like Glory Nursing to conduct your background check by checking one of the boxes below. 5. Background Check Process: - The background check will be conducted by an authorized third-party agency. You will be responsible for submitting all necessary information and payment for the background check as part of the enrollment process. - You will be notified of the results, and any disqualifying findings may result in removal from the program. Acknowledgment of Policy: By signing below, you acknowledge that you understand and agree to the terms of this waiver, including the requirement for a clean background check and the lack of any guarantee of employment after program completion.

At Glory Nursing, we are committed to fostering a supportive and fair learning environment. Students who have concerns or complaints related to any aspect of their experience at the school—including instruction, facilities, administrative services, or interactions with faculty/staff—are encouraged to follow the grievance process outlined below. No Refund Policy 1. Tuition and Fees: All payments made for tuition, registration fees, materials, and any other associated costs are non-refundable. 2. Course Withdrawals or Cancellations: Payments will not be refunded under the following circumstances: - Voluntary withdrawal by the student - Dismissal for academic or behavioral reasons - Schedule changes or conflicts In the event of medical or serious family reasons, Glory Nursing will work with students to make up lost classes by joining the next available classes. 3. Non-Attendance: Failure to attend classes—whether due to personal choice, illness, emergencies, or other reasons—does not entitle the student to a refund. Students are encouraged to assess their availability before enrolling. 4. Payment Plans: Students enrolled in a payment plan are required to complete all scheduled payments, regardless of course completion or attendance. 5. Course Cancellations by Glory Nursing: If a course is canceled due to unforeseen circumstances, students will be offered the option to reschedule or apply their payments toward another program. In such cases, no refunds will be issued. 6. Disputes: All disputes regarding payments or the no-refund policy must be submitted in writing to the school administration within 30 days of the payment in question. 7. Acknowledgment: By enrolling in Glory Nursing CNA School, you acknowledge and agree to the terms of this No Refund Policy. Your enrollment and payment of tuition or fees serve as confirmation of your understanding and acceptance of this policy.

Nurse Aide Registry — PO Box 268816, Oklahoma City, OK 73126-8816 — Ph. 405-426-8150 Required Information for Trainees (Effective July 23, 2015): HB2582 and Background Checks for Certified Nurse Aides (63 O.S. Section 1-1950.1). By signing below, I acknowledge that I have received, read, and understand the Nurse Aide Registry rules and regulations regarding background checks, certification, recertification, and reporting requirements as outlined by the Oklahoma State Department of Health.