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Center Student Handbook

Revised 9/22

Welcome!

Welcome to Iowa’s Blindness Empowerment and Independence Center (IBEIC)! You are taking an important step toward taking control of your life and not having blindness control your life. Learning new skills and breaking down the stereotypes and misconceptions concerning blindness will make your training a rewarding experience. We are excited to have you join our family of thousands of other blind individuals who have graduated the program and are working in their chosen vocational fields and fully living their lives.

As a comprehensive training program, the Blindness Empowerment and Independence Center includes both residential and instructional components. These are designed to give students maximum opportunity to learn non-visual skills, gain confidence and build positive attitudes related to blindness. Experience using these skills and attitudes in real-life situations is an important part of the program. Now that you have decided to become a student at the Center, here is important information which you will need as you begin your training program.

Section 1: Program Rules

Tools and Equipment

  • If a student loses or breaks any of the training tools provided by the Center, the student is responsible for replacing those tools.
  • Students are given an outdoor keycard for the IDB building and a standard key for the second-floor north areas. Students who lose the IDB building key must notify the Center’s Director immediately; the replacement cost for the IDB building key is $20.
  • Students receive maintenance money from the Iowa Department for the Blind (IDB) for costs directly related to training, such as food, laundry, and program-required activities. Students are required to keep all receipts accumulated during the month. Alcohol and cigarettes are not allowed on maintenance receipts. Students must submit a monthly log with receipts accounting for maintenance expenditures as required by federal regulations. Staff will work with students to understand this process.

Learning Shades

  • The Blindness Empowerment and Independence Center is a non-visual training program. Therefore, all Center students who have residual vision, even light perception, are required to wear learning shades during the training day, which runs from 8:00 a.m. to 4:30 p.m. Monday through Friday.
  • Students may remove your learning shades during the lunch period if they so choose. However, when attending a student meal, learning shades need to be worn. When completing a task, such as a travel route or cooking assignment, students must keep their learning shades on until the task is finished, even if the lunch hour or the end of the training day has arrived.
  • Learning shades are to be worn tightly enough that visual information cannot be obtained. Any questions about the Center’s learning shade procedures should be directed to the Center’s Director.

Training Expectations

  • Center students must use a long white rigid cane. Non-rigid canes such as folding or telescopic are not to be used. When not in their apartments, students must use their canes at all times, including evenings, weekends, and Center breaks. For example, students must use their canes when walking from their table to a vending machine or from one classroom to another, when they leave their apartment, or while in their home community.
  • Students are required to participate in training activities. These activities are designed to build self confidence and provide opportunities for students to use their skills in a number of different environments. Students are encouraged to suggest activities in which they are interested. These activities are an integral part of the core curriculum. Therefore, students are required to participate in training activities while wearing learning shades.
  • Students who have been in Center training for 3 months on July 1 of each year are required to attend one of the two national blindness organization conventions. Students can choose either the National Federation of the Blind or American Council of the Blind convention. Expenses for attending these conventions will be covered as part of the student’s vocational rehabilitation plan if the convention activities would be related to their employment goal. If the convention expenses cannot be paid through the student’s VR plan, expenses will be covered by a grant from IDB’s Gifts and Bequests fund.
  • Students are not permitted to loan money to other students or to purchase items, including meals, for other students. Students who have difficulty budgeting their money should speak with the Center’s Director. All receipts must be turned in before a student can receive their next maintenance check.
  • Students have access to a refrigerator and microwave in the Home Management area for lunches. Most students bring in a sack lunch from their apartment. Other options include having lunch delivered at the IDB front desk or purchasing items from the vending machines in the lobby area. It is the students’ responsibility to ensure their space is cleaned after eating. Food and beverages without lids, are not permitted in the computer or braille rooms at any time.
  • To aid speed of learning and transferability of skills, instructors will give students assignments to be completed non-visually outside the classroom. Students will be expected to complete these assignments on time.

Workplace Expectations

  • Students must keep phones on silent during class time and mandatory Center activities. If expecting an emergency call, students should alert the necessary Center staff during the class day. Talking time pieces are not permitted without permission from the Center Director.
  • As this is a pre-vocational training program, the dress code for Center students is business casual. Students are expected to follow the dress code that has been approved for IDB staff and can be found at https://blind.iowa.gov/manual#dress. Students will be given guidelines for appropriate dress during Center activities. On most Fridays, the agency has jean day when students can wear jeans. Staff will inform students of events where jean day will not be permitted. If you currently do not possess the required type of attire, let the Center Director know so options can be discussed. It will be useful to have this business casual clothing following training for interviews and employment.
  • Center students are prohibited from keeping dangerous weapons on Department premises, including in their apartments. Such weapons include but are not limited to firearms, explosives, poisonous gas, stun guns, antique and replica firearms, bows and arrows, knives with blades in excess of five inches in length, incendiary devices, switchblade knives, and stiletto. Any such weapons are subject to confiscation by Department staff and will be returned to students when training is ended.
  • Classes are scheduled from 8:00 A.M. to 4:30 P.M. which includes a scheduled lunch. Students are expected to be on time for all classes. Students are responsible for calling in before 7:30 in the morning if they are ill or for some other reason are unable to attend classes. Roll call is taken at 8:00 AM, followed by announcements. A student who is late or absent and does not call the Center by the time roll call is taken will be counted late/absent. Deductions will be made from student monthly maintenance for lateness and unexcused absences. Specific details about attendance and absences can be found later in this handbook under attendance guidelines.
  • Center students are expected to refrain from using or participating in the use of any form of communication that contains false, fraudulent, deceptive, or unfair statements or claims concerning fellow students, Iowa Department for the Blind staff members, or Center rules and guidelines in place within the Center.
  • Students are expected to follow the Professionalism guidelines, Anti-Discrimination Policy, and Violence-Free Training Environment Policy outlined below at all times while participating in the Iowa Blindness Empowerment and Independence Center program.

Counseling and Training Professionalism Standards for IDB Staff and Clients

To provide the most effective counseling and training possible, we need to create a climate of mutual respect. Everyone is expected too conduct themselves in a kind and professional manner. This means:

  • No one will make sexual comments or jokes.
  • No one will make derogatory statements or jokes about race, gender, gender expression, sexual orientation, religion, or disability, or that make negative generalizations about any group of people.
  • Everyone will use the preferred name and pronouns of the people with whom they are working.
  • Everyone will ask permission before touching another person.

Additional Information

By policy, IDB staff are not allowed to make social media friend requests or accept social media friend requests from anyone to whom they are actively providing services.

It is common practice for a teacher or counselor to touch a client’s hand, arm, or shoulder when working on learning to use a long white cane to travel independently, to teach a client how to safely use a kitchen knife, industrial arts tool, phone, keyboard, read or write braille, or other task outlined in your training plan or the program
curriculum. If a request for touch does not seem necessary or appropriate, you have the right to ask the purpose and/or refuse the request.

What do I do if I have concerns

If something has occurred that cannot be addressed directly with the teacher or counselor, please contact that individual’s supervisor.

  • The supervisor for Vocational Rehabilitation Counselors is Keri Osterhaus and she can be reached at (515) 205–8583 or Keri.Osterhaus@blind.state.ia.us.
  • The supervisor for Young Adult Transition Program, LEAP, and Vocational Rehabilitation Teachers is Helen Mejia and she can be reached at (515) 829–7411 or Helen.mejia@blind.state.ia.us.
  • The supervisor for Independent Living Teachers is Kim Walford and she can be reached at (515) 250–1184 or Kim.walford@blind.state.ia.us.
  • The supervisor for the Blindness Empowerment and Independence Center instructors is Karly Prinds and she can be reached at (515) 802–8162 or karly.prinds@blind.state.ia.us.
  • If the issue involves Rehabilitation Technology Specialists or a supervisor at IDB, please contact the IDB Director, Emily Wharton. She can be reached at 515–802–7313 or emily.wharton@blind.state.ia.us.

Disciplinary Action

It shall be noted as a breach of The Blindness Empowerment and Independence Center’s guidelines and rules to violate any set of rules set forth in this document . Any violation may lead to discipline up to and including termination from Center training.
The Center Director will conduct an investigation regarding any and all alleged violations of rules and if warranted, disciplinary action may follow. The Blindness Empowerment and Independence Center will generally follow the concept of progressive discipline, beginning with less severe disciplinary measures for the first offense. However, the seriousness of the offense may dictate a more severe disciplinary action and could result in suspension of training at the first offense if such action is warranted by the situation. Disciplinary actions or measures for Center students may include written reprimands and suspension of training.

Violence-Free Training Environment Policy

The Department recognizes that violence in the Blindness Empowerment and Independence Center can seriously affect the training, performance, attitude, and morale of Center students. Threats, intimidation, harassment, verbal abuse, or acts of violence will not be tolerated. The Department is committed to a violence-free training environment for all students and staff, and its goal is to prevent any violence from occurring within that environment.
Any student who has been the victim of violence within the Center environment, or who has a concern about potential violence within that environment, is directed to bring the matter to the attention of a Center instructor, the Center’s Director, or the Director of the Department. All complaints will be promptly investigated and appropriate action will be taken.

Anti-Discrimination Policy

The Department will not tolerate or condone any form of sexual or discriminatory harassment of students receiving training in the Blindness Empowerment and Independence Center.
Immediate action will be taken to stop harassment or discrimination where it exists. Students who believe they are the subject of sexual or other discriminatory harassment by Department staff or other students need to report their concerns to the Center’s Director. They may also report alleged discrimination to the Director of the Department or to the Iowa Client Assistance Program.

The Department also prohibits any form of harassment or other abusive conduct directed at Center students because of their race, sex, marital status, ethbnicity, religion, national origin, age, gender identity, sexual orientation, or mental or physical disability. Any harassment of this kind is also to be reported through the same process described above.

Apartment Rules

  • Students are responsible for keeping their apartments neat and clean and for reporting maintenance problems to the apartment office.
  • Quiet hours between the hours of 10:00 P.M. and 8:00 A.M. are standard rules in apartment buildings and must be observed by program participants living in student apartments.
  • Smoking is prohibited inside the student apartments, but is allowed 25 feet away from the building, which is the parking lot area, or the fence lines, which do offer grass and sidewalk space. We just kindly ask that butts are not tossed on the property and once cooled off are disposed of in the trash cans.
  • In accordance with Iowa State law, consumption of alcoholic beverages by anyone under the age of 21 is not allowed.
  • Firearms, weapons, and explosives are not permitted.
  • Illegal substances are not allowed in the apartments, and are grounds for immediate termination from the program.
  • In order to reduce cleaning and repair costs, IDB cannot allow pets of any kind in the student apartments.
  • Nails and tacks cannot be put in the walls or doors. Items may be hung with command strips.

Section 2: Helpful Information for New Students

Living in the Student Apartments

The student apartments are an integral part of the Center program. Living with other blind persons who are learning to deal successfully with blindness will help build your self-confidence, and practicing the skills learned in Center classes will help you learn them faster. Students are expected to use alternative techniques during the time they are in the student apartments and community, and to have their white cane with them at all times when they leave their apartments.

For their evening and weekend meals, students are expected to practice the food preparation techniques taught in Home Management class. Therefore, living on a preponderance of frozen, junk, and fast foods such as pizzas, potato chips, cookies, and colas is considered inappropriate while attending the program.

Apartment instruction takes place every other week, usually on Tuesday. Cleaning requirements will be fully explained to each student prior to the first scheduled instruction session. Apartment instruction is provided to make sure living quarters are kept neat and clean, and to identify areas in which students may need additional training. Minor cleaning problems found during instruction must be corrected by the student immediately; major problems must be corrected as designated by the instructor.

Students are responsible for keeping their own bedrooms and the shared living room and kitchen clean at all times. Roommates should share cleaning responsibilities in the communal spaces. Clean clothes must be hung in the closet or folded in drawers. Dirty clothes must be kept in a laundry receptacle. Towels must be hung on the towel rack. Bedding must be laundered at least every two weeks. Furniture and floors must be dusted, and clutter must be kept to a minimum. The trash can must be emptied when full. Any observed concerns regarding cleaning during apartment instruction will be integrated into Home Management class.

Upon arrival, students will be issued a key to the apartment building and their apartment; there is one mailbox key per apartment which is given to the first student that occupies the space. If you lock yourself out after hours, you will need to contact a locksmith to gain entry into your apartment. Jackson Crossing recommends Ian’s Lock and Key, which provides 24 hour service and is familiar with your apartment type of lock. You are welcome to use any locksmith you prefer. Please know that any damages incurred to the lock are at the cost of the resident to repair. If use of locksmith services are required, please notify apartment management by the next business day.

Locksmith Contact Info:
Ian’s Lock and Key
515–210–7282

If you lock yourself out during business hours, Jackson Crossing will provide an unlock service for you. The first lock out is at no cost, however, if you lock yourself out during business hours more than once in a year-long period, a $35 fee willl be assessed for the second and for each additional time. This means, that if someone formerly occupying your apartment has locked themselves out in the current year, even though this is your first time locking yourself out, you are still responsible for any fees incurred.

In the event of fire, crime or a medical emergency, students should call 911. Students may also call the Center Director once the emergency is reported and the student is in a safe location.

The student apartments are available only for students who are attending the Iowa Blindness Empowerment and Independence Center on at least a half-time basis. Students leaving the Center must immediately relinquish their space in the student apartments, and must take all personal belongings, including their industrial arts project, with them. Any item or industrial arts project left behind becomes the property of the Department for the Blind. Students must leave the apartment in as clean a condition as it was when they first arrived. In addition, they must make arrangements with the post office for having their mail forwarded before leaving.

What to bring with you

Students are expected to have and practice using a smart phone capable of non-visual access. They are expected to practice using their phone non-visually outside of class hours. If you do not have a non-visually accessible smart phone, your VR Counselor can help you to obtain one prior to entering Center training.

In order to learn and practice non-visual financial management skills, students are expected to have a bank account with a debit card. If you do not have this, your VR Counselor can help you to obtain one prior to entering Center training.

Each apartment is furnished with two chairs, two bar stools, end tables, beds, dressers, desks, and nightstands. Also, each apartment is equipped with various kitchen items including dinner plates, bowls, cups, glasses, pots and pans, silverware, etc. If you believe you will need more, you may bring them with you.

Small appliances which are not provided may be brought with you such as a toaster, television set, stereo, electric fry pan, deep-fryer, or coffee maker. If you like to cook and/or bake and have favorite kitchen or apartment tools, you may bring these items with you. If you decide to get cable or Internet service, you will be responsible for paying for these services.

Bedding for a full-sized bed (sheets, pillowcase, mattress pad, blankets, pillow, and bedspread) will be provided to you, however if you would like to bring your own; you are welcome to do so.

You will also need to bring bath towels, dishtowels, hand towels, washcloths, dishcloths, potholders, and cleaning supplies.

Moving into the Apartments

On the day you move into the apartments, you will go grocery shopping and to the bank to cash your maintenance check, accompanied by your student mentor and a Center staff member.

At the beginning of your training, the Center will provide you a long, white straight cane, a pair of learning shades, a slate and stylus, a braille watch, a talking alarm clock, and a monthly bus pass.

Your first month of training

So that you as a new student will have an opportunity to have a strong sense of independence, we ask that you agree to spend the first month, including weekends, in the apartments without going home for visits. Families and friends may visit you in the apartments during this time; however, they may not stay overnight in the apartments.

After the first month of training, you may have up to two family members as overnight guests in your apartment. However, plans for having overnight guests must be discussed with your apartment mate. If you are under the age of 18, you have a 10:00 P.M. curfew on week nights and a 12:00 A.M. curfew on weekend nights.

Traveling to and from the Center

While traveling to and from the Center each day, including to and from Center activities, students are required to take the bus or walk. Students are not allowed to take rides to and from the Center, or any outside Center activity during the training day from family or friends. This includes Ubers and Lyft. Exceptions may be made ahead of time for things such as doctors appointments with permission from the Center Director.

Medical Needs

The center does not have medical staff; therefore, students needing medical care should contact their doctor or the nearest walk-in clinic or emergency room. Students with an illness or medical condition that prevents them from attending classes for an extended period of time are expected to return home until they are again able to participate in classes and complete assignments.

Students are expected to manage their own prescription and over-the-counter medications. Students are also expected to follow their physician’s recommendations for taking medications. Any changes in medical conditions or medications that could impact training or effect the provision of emergency medical care should be reported to the Center Director so that emergency contact forms can be updated.

IDB Building Security

The IDB building is unlocked weekdays from 9:00 a.m. to 2:00 p.m. For this reason, personal possessions should not be left out in public areas. Fire doors are not to be propped open. In compliance with ADA regulations, the door located on Watson Powell has an automatic door open button; you must wait to confirm that the door has shut and latched before continuing into the building outside of business hours. If you come into the IDB building outside of business hours, you must check in and out with the apartment staff on duty by calling 515–249–6328.

Emergency Evacuations

If the fire alarm sounds, the elevators cannot be used. Students must exit the building immediately through one of several fire escapes, for which they will receive orientation when beginning the program. They must meet on the northwest corner of 4th Street and Watson-Powell then wait for the “all clear” signal before re-entering the building. If a tornado warning is announced, elevators can be used. Students must proceed immediately to the basement gym area and wait until an “all clear” announcement has been made.

Alcohol and Tobacco Use

Alcohol and all tobacco products are prohibited on Department premises including E-cigarette or vaping products. Department premises include the building’s roof, sidewalks adjacent to the building, and the Department’s side of the alleys. Cigarette butts must not be tossed on the property and once cooled off should be properly disposed of.

Use of the IDB Building Areas After Hours

Students have free access to the gym, vending area, roof, second-floor communications and kitchen areas, and second-floor south before and after business hours and on weekends. These areas must be kept clean and litter free.

Section 3: Training Progress Expectations and Evaluation

The Blindness Empowerment and Independence Center is a pre-vocational training center and thus expects that students will meet or exceed expectations set forth in the training program. If students do not meet expectations, coaching and guidance will follow.

In addition to following the rules set forth in this manual, Center students are expected to:

  • Students are expected to socialize positively with and mentor their fellow students.
  • Students are expected to put forth consistent effort in all classes.
  • Students are expected to complete in class and out of class assignments as directed.
  • Students are expected to communicate with instructors and their VR Counselor regarding changes in their vocational goals.
  • Students are expected to develop or maintain habits and behaviors regarding time management, personal organization, self-sufficiency, physical and mental health in alignment with those expected in their chosen vocational field.

Progress Monitoring

A checkpoint will be held with each student, Center staff, and their VR Counselor at the six week and five month points of training. This will help to ensure that students are on track for meeting their graduation timeline. Students will discuss their goals and progress monthly with each of their instructors.
Meetings with the Center Director, a student, and their VR counselor may be called to discuss concerns or make arrangements for additional service needs.

Key Work Behaviors

Because the Iowa Blindness Empowerment and Independence Center is a pre-vocational program, students will be evaluated and coached on their demonstration of key workplace behaviors. These behaviors are necessary for success in employment and center training is an excellent opportunity to learn and strengthen these behaviors. VR Counselors and Center Instructors will discuss with students how these behaviors would be enacted in each student’s chosen vocational field.

  • Shows up on time to class.
  • Gets to work and will self-start rather than waiting for instructor.
  • Completes out of class assignments.
  • Treats colleagues with respect and acts in a professional manner with instructors.
  • Maintains Professional appearance.
  • Work is thorough and tasks are completed thoroughly.
  • Communicates issues and concerns in a professional manner.
  • Attempts to problem solve before seeking assistance from others.
  • Follows time off request procedures.
  • Contributes to group projects.
  • Works to increase efficiency and proficiency with important work tasks.
  • Works steadily and stays on task through the entire class period.
  • Brings needed tools for writing down and reading back notes and other important informations

Graduation Requirements

In order to receive a signed graduation certificate from the Iowa Blindness Empowerment and Independence Center, a student must
1. Complete a post-center plan that is approved by the Center Director and IDB Director.
2. Be determined eligible to graduate based on the below criteria as evaluated by Center instructors and approved by the Center Director.

Graduation Evaluation Questions

 

1 Question:

Is this student as competent, self-sufficient, and likely to succeed as they would be if they were not blind?
 
If everyone answers “yes” to this, there is no need to ask any further questions. If instructors are unsure or think maybe not, the following questions should clarify or point out areas of improvement:
 
* When confronted with a new task, does the student proceed on the assumption that it can be done without vision or do they act as if they assume that it will require sight?
* Has the student taken control of their training?
* Can the student think of several ways to perform a task and weigh the merits of each?
* Will the student go somewhere they have never been before by themselves?
* Will the student explore their environment before asking for information from a sighted person?
* Is the student able to gracefully decline unwanted help?
* Does the student get useful information from sighted people or expect the sighted person to guide them?
* Does the student trust the information they receive from their cane and other senses or do they seek visual confirmation?
* Does the student actively practice the alternative techniques they are learning or do they default to a visual method (writing notes with a sharpie, using a print menu, etc.)?
* Does the student recognize when the information they are getting from their cane and other senses indicates that there is a problem (i.e. walking in the street, have made an undesired turn, etc.)?
* Will the student be able to perform all the travel required of someone in their chosen career?
* Does the student have a non-visual method for jotting down information such as a phone number and labeling personal items?
* Can the student deal with printed material at a level that would be expected from a person in their career field?
* Can the student produce documents and other computer files with the efficiency expected of someone in their career field?
* Does the student have and use a non-visual way of keeping track of appointments and contacts? 
* Does the student understand how braille will benefit them in their career and personal life?
* Has the student worked to learn braille to a level in line with their intellectual and physical ability to do so?
* Does the student understand the benefits and limitations of access technology?
* Can the student teach themselves new programs that are similar or share common elements with those they already know?
* Does the student appear confident to those around them?
* Has the student made a plan for life after graduation?
* Does the student teach and encourage newer students?
* Can the student take care of their home?
* Would the student show up for a job interview looking similar to other candidates for that position?
* Does the student feel comfortable talking about blindness with potential employers?
* Does the student consider themself blind?
* Does the student treat blind people with generally the same amount of respect they do sighted people?

Section 4: Attendance Expectations

Regular attendance in the Blindness Empowerment and Independence Center is critical to success both in the Center and in future employment. Students are expected to demonstrate progress in learning the alternative techniques of blindness and to demonstrate a sincere and positive effort to deal with their attitudes about blindness.

Lateness

If you are going to be late at the beginning of the day, you must call the Center’s Director at 515–802–8162 by 7:30 a.m. If you are going to miss or be late for a class, you must let your instructor know as soon as possible. Do not ask another student to make these calls for you.

Appointments:

Students must calendar any appointments or vacations outside of scheduled Center breaks with the Center’s Director. More than five days absence from training may result in the loss of maintenance for that time. Unauthorized or extended absences from training may lead to suspension in training.

Illness

If you will miss classes due to illness, you need to notify the Center’s Director at 515–802–8162 by 7:30 a.m. Do not ask another student to make this call for you. Students who miss classes due to illness during the day are not permitted to participate in activities in the evening, including eating out or using the gym facilities.

Extended Illness

If your illness lasts longer than three days, you will be asked to visit a medical clinic for a written diagnosis, which you must give to the Center’s Director. Students who are ill for four or more days and/or are experiencing an acute illness will be sent home to receive care from their primary physician. These students may return to the program at the discretion of the Center’s Director and with a written release from their physician.

Center Schedules

A standard Center Schedule for all students is Monday through Friday 8 a.m. - 4:30 p.m. with a lunch from 12:30 p.m. - 1:10 p.m. Unless leave has been approved, all students are expected to be in their classes from the designated starting time, to the designated end time. On Wednesdays, students are expected to be in their student council meeting from 1:10 p.m. –2:00 p.m. All Center activities, large meals, graduations, and any other special events requested by the Director will be mandatory.

Unscheduled Absences

Students must follow the rules as outlined in the student handbook for the day of leave, and leave requests should be submitted on the day the student returns to classes. If the student is unable to fill out a leave slip, they must meet with an instructor for instruction and/or guidance to complete.
If attendance continues to become a problem, i.e. patterns noticed, etc., participation in the Blindness Empowerment and Independence Center will be reviewed and the student may be suspended from training.

Scheduled Leave

When a student wants time away for vacation, medical appointments, or other reasons, the student is responsible for requesting leave from the Director no less than 24 hours in advance. The Director will approve or deny leave at their discretion. Leave requests might be denied for reasons including activities planned for that time period, or too many instances of uncompleted work.
If you will be missing days due to vacation, each day you are absent, the maintenance amount per day will be deducted.

Acknowledgement

This handbook is a statement of both the mandated rules, and the common sense rules used to promote and maintain high standards of behavior and promote a positive, productive, and professional environment in preparation for the working world following graduation from the Center.

I understand these rules and guidelines and agree to abide by them during my Center training in the Iowa Blindness Empowerment and Independence Center. I have been given the opportunity to as questions and obtain clarification. I understand that my failure to do so may lead to disciplinary action up to and including suspension of training or termination from the program.

Signature: Date: