Registration Form. Study course. MAS in Cardiovascular Perfusion. Course begins: upon consultation. Registration deadline:

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Please leave blank Registration Form Study course MAS in Cardiovascular Perfusion Course begins: upon consultation Registration deadline: 31.03.2018 Seite 1/8

Final Registration Personal Details Surname First name Street Postcode, City Canton Please attach current photo Please also send an electronic photo to: gesundheit@ kalaidos-fh.ch National Insurance Number (AHV) Date of Birth Place of Birth Nationality Phone (home) Phone (work) Mobile phone Email (home) Email (work) Details of Employer Name of Institution Name of Contact / Line Manager Department / Clinic Current Position of Contact Person Street Postcode, City Canton/State Phone Contact Person Email Contact Person Seite 2/8

Study Fees The study fees are usually borne by the contracted organisation. The contracted organisation's regulations apply. For foreign students in transfer programmes each module normally costs CHF 2050.-. Costs such as travel expenses, books, laptop etc. are borne by the student. I had vocational training in Cardiovascular Perfusion Degree: Admission requirements - Apprenticeship as Qualified Nursing Professional HF/FH (or an equivalent accredited degree) - Apprenticeship in anaesthesia care or apprenticeship in intensive care (or admission sur dossier / portfolio) - To be able to read and understand English expert literature and to be able to follow classes taught in English - Prospect of an internship in the area Cardiovascular Perfusion - Admission interview Seite 3/8

Details of education and professional training Please attach photocopies of corresponding documents. Completed Degree (tertiary level A) Year Completed University Degree Field of study: Completed University of Applied Sciences Degree Field of Study: Completed Apprenticeship(s) (tertiary level B) Year Apprenticeship in anaesthesia care or apprenticeship in intensive care Apprenticeship as Qualified Nursing Professional Professional Postgraduate Training with Degree Year Completed Secondary Level II Training Year 3 years of Intermediate Diploma School, Business College, Vocational Secondary School High School with A-level Swiss Certificate of Competence as Federal Vocational Baccalaureate, field: Equivalence to the Federal Vocational Baccalaureate if no Intermediate Diploma School, Business College, Vocational Secondary School, A-level/Baccalaureate Please enclose evidence or request documents. English (First certificate or evidence of equivalent level) Seite 4/8

Professional Experience From (month/year) To (month/year) Position Workload Current professional practice (please provide address) Institution: Position: Street: Postcode / City: Comments: Internship in the area of cardiovascular perfusion (please provide address) Please attach a confirmation of the institution where the internship will be undertaken.* Institution: Street: Postcode / City: Comments: * The confirmation can be submitted up until 6 weeks before the start of the study course. Seite 5/8

Invoice Invoices are issued in instalments (per module). Different forms of payment may be made with the Admission Office. The invoice of the study fees may be sent to: Home address Employer *) *) If the invoice is sent to the employer, please provide confirmation. Registration I accept the contract requirements (see page 7) and register. Place, date: Signature: Attachments I attach the following documents to the registration form: All the documents must be handed in, if available. 1 current passport photo (additionally, for the student ID card) Photocopies of completed apprenticeship(s) secondary level II Photocopies of completed apprenticeship(s) tertiary level Photocopies of professional postgraduate training with degree Photocopies of last school certificate (e.g. secondary school, apprenticeship, etc.) Grades of the subjects German, English and Maths Confirmation of internship Confirmation of employer, if invoice is issued to them The Programme Director will examine your registration documents and contact you by phone to arrange an admission interview. You will receive a written confirmation of your registration after the admission decision has been made. Please send registration documents to: Kalaidos Fachhochschule Gesundheit (University of Applied Sciences, Department of Health Sciences), Studiensekretariat (Admission Office) Pestalozzistrasse 5, CH-8032 Zürich Seite 6/8

Contract Terms and Conditions MAS in Cardiovascular Perfusion Registration For registration the registration form has to be completed. Confirmation of Registration The contract between the student and the Kalaidos University of Applied Sciences, Department of Health Sciences is completed with the student's registration and written confirmation by the admission office. Registration Deadline, Registration Fee The registration deadline is defined in accordance with the registration form. The registrations are considered in the order of their arrival. Cancellation due to Subparticipation The Kalaidos University of Applied Sciences, Department of Health Sciences explicitly reserves its right to cancel the course 6 weeks before course begin the latest, due to subparticipation or other circumstances which make carrying out the programme impossible. In this case payments already made will be fully refunded. Further compensation claims are excluded. Financial Regulations Invoices of study fees are due before the beginning of each module. In the case of absence from class, deductions from the study fees or module fees cannot be claimed. This applies also to absence due to military service, illness, holidays or professional workload. There will be additional fees for resits and re-examinations. Students who are employed by a Swiss hospital or are doing an internship in a Swiss hospital, arrange their financial contributions with the employing cooperating hospital. Expenses such as books, journeys, laptop etc. are borne by the students. Price Guarantee The study fees according to the registration form are valid at the time the registration form is submitted. In case of the resumption of studies after a cancellation or an interruption of more than one year the then valid fees become effective. Withdrawal Before Start of the Course If the notice is handed in within 8 weeks before the start of the course, an additional reimbursement for expenses of CHF 800.- is due. Fees already paid will be refunded. The notice has to be made by registered letter. Withdrawal During the Course At the end of each module a withdrawal from the course is possible. 6 week before the start of the next module the notice with a registered letter must be with the Kalaidos University of Applied Sciences, Department of Health Sciences. In case of noncompliance with the deadline a reimbursement for expenses of CHF 800.- is due. If notice is submitted after the beginning of the module the module will be fully offset. Fees already paid for further modules will be refunded. Withdrawal Due to Non-Compliance with Promotion Requirements If the student does not pass the exams and, if applicable, resits scheduled according to the examination regulations, a cancellation of the contract for the students due to the non-compliance of the Promotion requirements is possible. Fees already paid for subsequent modules will be refunded. Insurance The attainment of accident insurance, health insurance and liability insurance is up to the student. Final Regulations The Kalaidos University of Applied Sciences, Department of Health Sciences reserves the right to make changes to the study programme and to the management in terms of improvement. Data Protection The student explicitly accepts that his/her details (name, address etc.) are saved for internal use only and that they may be used for e.g. marketing purposes of the Kalaidos University of Applied Sciences, Department of Health Sciences. The student's details have to be forwarded to the Federal Statistical Office. Data protection and security are guaranteed by the Federal Statistics Law and the Data Protection Law. The Federal Office's use of the information is permitted for statistical purposes only. Confirmation I confirm that within the last two years I have not been suspended definitively from a study programme of the same field of study nor of the same degree. I accept the terms of the contract. Place, date: Signature: Seite 7/8

Filled in by the University: Sec. Level II EFZ DMS / HMS / FMS BM gymnasiale Matur Equivalence Federal Vocational Baccalaureate (BM) registered G E M passed Degree tertiary level Professional postgraduate training PFP HF NDS Intensiv NDS Anästhesie PFP BScN HöFa II To the study course admitted (admission criteria fulfilled) admitted with attendance of the module Research Results: Findings and Evaluation admitted, subject to reservation... not admitted Reasons:... The following modules can be taken into account/transferred/credited:.... Date / Visa:.. Seite 8/8