Student Enrollment Agreement
South Florida Dental Assisting School

PERSONAL INFORMATION: All fields MUST be filled out. If any fields to not apply, enter NA.

Name:

E-mail:

Address:

City:

State:

Zip:

Phone (Home):

Phone (Work):

Phone (Cell):

How were you referred to SFDAS?

EDUCATION HISTORY

High School Graduate:*

Yes No

GED:

Yes No

Have you attended a College/Technical Institution:*

Yes No

PROGRAM INFORMATION:

Program Title:

DENTAL ASSISTING

Clock Hours : 112

Class
Schedule:

CLASS START DATE	EXPECTED GRADUATION DATE	DAYS / TIMES
December 3, 2011	February 25, 2012	Saturday, 9:00 a.m. - 3:30 p.m.
January 17, 2012	April 5, 2012	Tuesday & Thursday, 6:00 p.m. - 9:00 p.m.
March 31, 2012	June 16, 2012	Saturday, 9:00 a.m. - 3:30 p.m.

CANCELLATION & REFUND POLICY:

Should students be terminated or cancel for any reason, all refunds will be made according to the following refund schedule:

Cancellation must be made in person or by certified mail.
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 initial payment.
Cancellation after the third (3rd) business day, but before the class, will result in a refund of all monies paid, with the exception of the registration fee.
Cancellation after attendance has begun, but prior to 40% completion of the program, will result in a prorated refund computed on the numbers of hours completed to the total program house.
Cancellation after completing 40% of the program will result in no refund.
Termination Date: The termination date for the refund computation purposes is the last date of actual attendance by the student unless earlier written notice is received.
Refunds will be made within 30 days of termination or receipt of Cancellation Notice.
A student can be dismissed, at the discretion of the Director, for insufficient progress, non-payment of cost, or failure to comply with rules.

Tuition:

TUITION	$3,470.00
REGISTRATION FEE (NON-REFUNDABLE)	$25.00
TOTAL COST	$3495.00

Payment:

METHOD OF PAYMENT Note: A tuition deposit of $300.00 will be required prior to the first week of class to secure your enrollment position. This deposit will be credited toward your tuition.
	Full payment at any time of signing enrollment agreement.
	Registration fee at time of signing enrollment agreement, tuition in three payments: 1/3 first week, 1/3 fifth week, and 1/3 ninth week.
	Registration fee at time of signing enrollment agreement, tuition in weekly payments.

All prices for program are printed herein. There are no carrying charges, interest charges, or service charges connected or charges with any of these programs. Contracts are not sold to a third party at any time. Cost of credit is included in the price costs for the goods and services. Payment can be made by cash, check, money order, Visa, Master Card, Discover, and American Express.

Upon successful completion of the program, the school will assist each graduate with job placement: however, the school does not guarantee employment. A diploma will be issued to each student who successfully completes the program and satisfies all requirements.

NOTICE TO BUYER: Do not sign this contract before you read it or if it contains any blank spaces. You are entitled to an exact copy of the contract you sign. Keep it to protect your legal rights. This agreement, along with the catalog, constitutes a binding contract between the student and the school upon acceptance by the school.

STUDENT SIGNATURE (Please type complete name)

DATE

I understand that there is a $25.00 non-refundable registration fee to be included with my application.
*Documentation of graduation is required.

Student Enrollment Agreement South Florida Dental Assisting School

Student Enrollment Agreement
South Florida Dental Assisting School