Education CD Enrollment Form

Education CD Enrollment Form

Institution Name:

Student Information

Date of Birth:   Student ID:

Primary Phone:   Email:

Parent / Guardian (If Student is a Minor)

Is the student under 18 years of age?   Parent/Guardian Name:

Parent/Guardian Phone:   Parent/Guardian Email:

Program Enrollment Details

Program Code:   Start Date:   Expected Completion Date:

Tuition & Payment

Total Tuition and Fees: $   Materials/Assessment Fee: $

Pay in full by the first day of instruction
Installment plan — Number of installments:   Amount per installment: $
Scholarship or assistance applied (explain below)

Payment Method (check one):
Credit/Debit Card
Check
Other (describe below)

Health, Emergency & Accommodations

Emergency Contact Phone:   Relationship:

Authorizations, Policies & Acknowledgments

Enrollment Acceptance: By signing this form, the student or parent/guardian certifies that the information provided is accurate and complete. Enrollment is subject to acceptance by the institution. Acceptance is contingent upon payment of required tuition, fees, and any documentation requested by the institution.

Payment and Collection: All charges are due in accordance with the selected payment plan. The institution may assess late fees and pursue collection for unpaid balances. The student or responsible party agrees to pay all charges and collection costs, including reasonable attorney fees and court costs where permitted by law.

Refund and Cancellation Policy: Refunds, if any, will be calculated based on the institution's published refund schedule measured from the program start date. No refunds will be issued for materials consumed or services rendered. Withdrawals must be submitted in writing to the institution. Refunds will be processed in accordance with institutional policy.

Academic Standards and Conduct: The student agrees to abide by the institution's academic policies, code of conduct, attendance requirements, and procedures for academic integrity. Violations may result in disciplinary action, including dismissal from the program without refund.

Intellectual Property and Course Materials: Course content, materials, and assessments are the property of the institution or its licensors. The student agrees not to reproduce, distribute, or publicly display such materials except as expressly authorized in writing by the institution.

Liability Release: To the fullest extent permitted by law, the student and parent/guardian release the institution and its employees from liability for personal injury, property damage, or other loss arising from participation in program activities, except for willful misconduct or gross negligence.

Media and Directory Information: The institution may photograph or record classes and events for educational and promotional purposes. Check one:
I consent to use of my or my child's image/recordings for institutional purposes.
I do not consent.

Release of Records: The institution may release directory information as permitted by institutional policy and applicable law unless the student or parent/guardian requests confidentiality in writing.

Additional Information

Certification and Signature

By signing below, I certify that I have read, understand, and agree to the terms, policies, and acknowledgments stated in this Enrollment Form. I further certify that all information provided on this form is true and complete to the best of my knowledge.

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