AAA School of Dental Assisting

SEA-01-APP-2018-ENR10


STUDENT ENROLLMENT AGREEMENT

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:

Mailing Address: 

 

General Information
S.S.N D.O.B Gender Status Ethnicity

 

Contact Information
Cell Phone Home Phone Email
     

 

Emergency Contact Information
Name Relationship Phone
 

 


 

Dental Assisting Program Schedule

Enrollment Campus:

Location:  

Enrollment Schedule Information:

Course Start Date:  

Course Schedule 1st Selection:

Course Schedule 2nd Selection:  

 


 

Financial Information and Disclosures: 
All Books and Materials are included in the program fees.

Program Price: $4000.00

 

Tuition Payment Details:

Tuition Payment Type:  

Application Fee: $75.00

Deposit Amount Paid:  

 

 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 in the contract.
(N/A, if not applicable or line through)

Finance Charge
– None –
Application Fee
$75.00
Down Payment
$700.00
Subscription Terms
Amount Financed

YOUR PAYMENT SCHEDULE WILL BE:  Payments

Number of Payments

Amount of each payment

Automatic Recurring Billing

10-Payments

$250.00 

Payments Managed by Authorize.net ARB: YES

     

 

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 of 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.

 

ACKNOWLEDGMENT

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:

Leave this empty:

Signed by AAA Soda
Signed On: November 2, 2018

AAA School of Dental Assisting https://aaasoda.com
Signature Certificate
Document name: SEA-01-APP-2018-ENR10
Unique Document ID: a81d63d6f7f4dd21db20eef2d9a8b5e97e91b8b6
Timestamp Audit
November 2, 2018 3:21 pm ESTSEA-01-APP-2018-ENR10 Uploaded by AAA Soda - web@aaasoda.com IP 165.225.32.111