AAASoda School of Dental Assisting
Document ID: ec682b87ef193dc95b79fa08faa14511e4c91e69
March 26, 2017
Signed On : http://aaasoda.com

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


 

Student Information:

Name: anthony balsam

Mailing Address:
335 brookhaven pl
lake mary, Florida 32746
United States

 

General Information
S.S.N D.O.B Gender Status Ethnicity
222-22-2222 05/25/1987 Male White

 

Contact Information
Cell Phone Home Phone Email
(407) 474-5529     anthony@aaasoda.com 

 

Emergency Contact Information
Name Relationship Phone
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:  

 

ab 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)

A.P.R.
N/A
Finance Charge
N/A
Amount Financed
N/A
Total of Payment
N/A
Total Sales Price
N/A

YOUR PAYMENT SCHEDULE WILL BE: (NOT APPLICABLE)

Number of Payments

Amount of each payment

When payments are due

NA 

$0  

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:

  1. Cancellation can be made in person, by electronic mail, by Certified Mail or by termination.
  2. All monies will be refunded if the school does not accept the applicant or if the student cancels within three (3) business days after signing the enrollment agreement and making the initial payment.
  3. Cancellation after the third (3rd) Business Day, but before the first class, results in a refund of all monies paid, with the exception of the registration fee (not to exceed $150.00).
  4. Cancellation after attendance has begun, but prior to 50% completion of the program, will result in a Pro Rata refund computed on the number of hours completed to the total program hours.
  5. Cancellation after completing 50% of the program will result in no refund.
  6. Termination Date: In calculating the refund due to a student, the last date of actual attendance by the student is used in the calculation unless earlier written notice is received.
  7. Refunds will be made within 30 days of termination of students’ enrollment or receipt of Cancellation Notice from the student.

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.

 

GRADUATION REQUIREMENTS

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.

 

EMPLOYMENT ASSISTANCE

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.

 

ACKNOWLEDGEMENT

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.

 

Signed on: July 26, 2017

anthony balsam

Signed by anthony balsam
Signed on: July 26, 2017

Signed by AAA Soda
Signed On: July 24, 2017

Signature Certificate
Document name: SEA-01-APP-2017 - anthony balsam
Unique Document ID: ec682b87ef193dc95b79fa08faa14511e4c91e69
anthony balsam
Party ID: a7298a44-73ea-451b-8b1e-9f1b7ccd7318
IP Address: 192.210.150.220
Security Level: E-mail
Digital Signature:
anthony balsam
Multi-Factor
Digital Fingerprint Checksum
01db6b4aac4639addb4ea2cff50450de
Timestamp Audit
2017-03-26 11:37:07 EDTSEA-01-APP-2017 Uploaded by AAA Soda - esign@aaasoda.com IP 184.89.167.250
2017-07-26 18:39:46 EDTDocument sent for signature to anthony balsam - anthony@aaasoda.com
2017-07-26 18:40:20 EDTDocument viewed by anthony balsam - anthony@aaasoda.com IP 184.89.173.137
2017-07-26 18:41:34 EDTDocument signed by anthony balsam - anthony@aaasoda.com IP 184.89.173.137
2017-07-26 18:41:34 EDTThe document has been signed by all parties and is now closed.
2017-07-26 18:44:02 EDTDocument viewed by anthony balsam - anthony@aaasoda.com IP 184.89.173.137
2017-07-27 04:51:11 EDTDocument viewed by anthony balsam - anthony@aaasoda.com IP 23.20.193.33