ENROLLMENT AGREEMENT

 

This form is needed to guarantee your place in the course(s) you have registered for.

Please sign and return to the School 3 weeks prior to the course date.

 

All students must complete this section

 

Name: ____________________________________________________________

 

Address: _________________________________________________________

Telephone

Home _____________________ Work ______________ Cell_____________

 

Email: ___________________________________________________________

 

Non-refundable

COURSE TITLE                                 Credit Hours DATES    DAYS/ TIMES    DEPOSIT     TUITION BALANCE

 

1.

2.

3.

4.

 

Payment Check, Credit or Debit Card ($35.00 fee for returned checks and or declined credit cards)   Credit or Debit Card _______________________________________

 

Expiration date ________________ Security Code__________________________

 

$100.00  Application fee (non- refundable and good for life)

Termination Policy:

Any student that has violated the policies of attendance, grading, misconduct and have not fulfilled their financial responsibility shall be terminated from the program.

 

“It is the responsibility of the student, to check with the licensing agency of your state, country or province on CEU/CME requirements. “

 

 

____________________________________                   _______________________

Signature                                                                                  Date