SEA-01-APP-2017 - anthony balsam
THIS AGREEMENT, TOGETHER WITH THE SCHOOL CATALOG, CONSTITUTES A BINDING CONTRACT BETWEEN THE STUDENT AND THE SCHOOL UPON ACCEPTANCE BY THE SCHOOL.
READ APPLICATION THOROUGHLY BEFORE SIGNING
Entry Level Dental Assisting with Expanded Functions | Course Term: 12 weeks | Clock Hours: 109
Name: anthony balsam
335 brookhaven pl
lake mary, Florida 32746
|Cell Phone||Home Phone|
|Emergency Contact Information|
|cheryl balsam||Parent / Guardian||(407) 284-0627|
Dental Assisting Program Schedule
Enrollment Schedule Information:
Course Start Date: August 30, 2017
Course Schedule 1st Selection: Monday & Friday 9:30-2:30
Course Schedule 2nd Selection: Tuesday & Thursday 9:30-2:30
Medical Scrub Size: Large
Financial Information and Disclosures:
Total Program Price: $4,075.00
*** Books and Materials are included in total costs of the program.
Tuition Payment Received:
Application Fee Paid: $75.00
Tuition Remaining Balance:
I acknowledge and understand that this agreement constitutes a binding contract between the undersigned student and AAA School of Dental Assisting.
NOTE: For School offering a payment plan with four or more payments the federal boxes or vertical listing must be included on the contract.
(N/A, if not applicable or line through)
|Total of Payment
|Total Sales Price
YOUR PAYMENT SCHEDULE WILL BE: (NOT APPLICABLE)
Number of Payments
Amount of each payment
When payments are due
Payments to commence on NA
Set payment frequency: NA
All prices for the program are printed herein. There are no carrying charges, interest charges, or service charges connected or charged with any of these programs. Contracts are not sold to a third party at any time. The cost of the class is included in the price cost for the goods and services.
CANCELLATION AND REFUND POLICY
Should a student’s enrollment be terminated or canceled for any reason, all refunds will be made according to the following refund schedule:
GROUNDS FOR TERMINATION
I agree to comply with the rules and policies and understand that the School shall have the right to terminate this contract and my enrollment at any time for violation of rules and policies as outlined in the catalog. I understand that the School reserves the right to modify the rules and regulation and that I will be advised of any and all modifications.
I understand that in order to graduate from the program and to receive a diploma, I must successfully complete the required number of scheduled clock hours as specified in the catalog and on the Student Enrollment Agreement, pass all written and practical examination with a 75% average and satisfy all financial obligations to the School.
I understand that the School has not made and will not make any guarantees of employment or salary upon my graduation. The School will provide me with placement assistance up to six months after graduation, which will consist of identifying employment opportunities and advising me on appropriate means of attempting to realize these opportunities.
This contract contains the entire agreement between the School and myself, and no further modification or representation except as herein expressed in writing will be recognized.
ALL SIGNERS HEREIN AFFIRM AGREEMENT AND RECEIPT OF THE BINDING DOCUMENT AND SCHOOL CATALOG.
|2017-03-26 11:37:07 EDT||SEA-01-APP-2017 Uploaded by AAA Soda - firstname.lastname@example.org IP 184.108.40.206|
|2017-07-26 18:39:46 EDT||Document sent for signature to anthony balsam - email@example.com|
|2017-07-26 18:40:20 EDT||Document viewed by anthony balsam - firstname.lastname@example.org IP 220.127.116.11|
|2017-07-26 18:41:34 EDT||Document signed by anthony balsam - email@example.com IP 18.104.22.168|
|2017-07-26 18:41:34 EDT||The document has been signed by all parties and is now closed.|
|2017-07-26 18:44:02 EDT||Document viewed by anthony balsam - firstname.lastname@example.org IP 22.214.171.124|
|2017-07-27 04:51:11 EDT||Document viewed by anthony balsam - email@example.com IP 126.96.36.199|