Academic Premium Package Form

ACADEMIC PREMIUM PACKAGE FORM

Student Information

Student Name:    Date of Birth:

Parent / Guardian (if minor)

Package Selection

Select the Academic Premium Package tier. Only one tier may be selected and selection authorizes enrollment in the specified services and fees described below.

Basic Premium — Core academic resources, 4 advisory hours/term, access to digital study library.
Premium Plus — All Basic features plus weekly tutoring (up to 8 hours/month), priority advising.
Elite Premium — All Premium Plus features plus exam prep workshops, personalized success plan, extended tutoring.

Service Components (check all that apply)

Individual tutoring sessions
Group workshops and study labs
Priority academic advising
Exam preparation courses
Extended digital resource access

Term and Fees

Desired Package Start Date:    Term Length:

Payment Option: One-time payment Monthly installments Scheduled installment plan

Academic Policies and Acknowledgments

By enrolling in the Academic Premium Package, the student and parent/guardian (if applicable) acknowledge and agree to the following terms. These provisions form a binding agreement between the undersigned and the institution providing the services:

1. Services and Scheduling: Services are provided subject to availability. The institution will make reasonable efforts to accommodate requested scheduling; however, the institution is not liable for missed sessions resulting from rescheduling by the student without timely notice.

2. Attendance and Preparation: Students are expected to attend scheduled sessions and complete preparatory work. Repeated cancellations or no-shows may result in suspension of services without refund.

3. Cancellation and Refunds: Deposit is non-refundable except as required by applicable consumer protection law. Refund and prorating policies for term cancellations are as follows: if cancellation occurs within the first seven calendar days of the term, a partial refund may be issued less a processing fee; thereafter refunds are discretionary and subject to administrative approval.

4. Limitation of Liability: The institution's liability for any claim arising out of the services is limited to the amount paid by the student for the package. The institution is not responsible for indirect, incidental, or consequential damages.

5. Academic Integrity: All students must comply with the institution's academic integrity policies. Breaches may result in termination of services without refund.

6. Materials and Intellectual Property: Course materials provided as part of the package remain the intellectual property of the institution and may not be redistributed without written permission.

I acknowledge that I have read, understand, and agree to the Academic Policies and Acknowledgments set forth above.

Privacy, Data Use, and Media Consent

The institution collects and processes student personal data necessary to provide services. Data will be retained and used for administrative and instructional purposes. The undersigned consents to the collection and use of data as required for provision of services and acknowledges the institution's right to use non-identifying aggregate data for educational assessment.

Media Consent: I grant permission to record or photograph the student during program activities for use in institutional promotional and instructional materials (no financial compensation).

Emergency Contact & Medical Information

Special Accommodations

Consent and Certification

By signing below, the undersigned certifies that the information provided in this form is true and complete to the best of their knowledge, that they are authorized to enroll the student in the selected package, and that they agree to be bound by the terms, fees, and policies stated herein. If the student is a minor, the parent/guardian signing below hereby consents to the student's participation and accepts financial responsibility for fees incurred.

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