23 Jackson Avenue North
Jacksonville, Florida 32220
Student Enrollment Agreement
ALL SIGNERS MUST RECEIVE AND READ A COPY OF THE BINDING
DOCUMENT AND CATALOG.
STREET ADDRESS CITY/STATE ZIP/POSTAL CODE
Name of Parent/Guardian (if student is under 18): _____________________________________
Telephone: (Home) _______________________ (Business or Cellular): ____________________
Social Date Circle
Security Number: ______________________ of Birth: ________________ One: Male Female
Title: NURSING ASSISTANT n Clock Hours: 120
Class Schedule: ( X ) full time ( ) part time ( ) Day Classes ( ) Evening Classes
Hours per Week: _____________ Start Date: ___/___/___ Anticipated Ending Date: ___/___/___
Tuition $ _790.00
Registration Fee $ __50.00
Books $ __55.00
Materials $ ______
Total Program Cost $ 895.00
Goods or Services not
included in the tuition $ ______
Page 1 of 3
METHODS OF PAYMENT
[ ] Full payment at time of signing enrollment agreement.
[ ] Registration fee at time of signing enrollment agreement with balance paid prior to graduation.
NOTE: For Schools offering a payment plan with four or more payments the federal boxes or
vertical listing must be included on the contract. (ENTER N/A or LINE THROUGH if not applicable)
ANNUAL FINANCE CHARGE AMOUNT FINANCED TOTAL OF PAYMENT TOTAL SALES PRICE
PERCENTAGE RATE The dollar amount the The amount you will have The total cost of your
credit provided to you paid after you have made purchase on credit including
or on your behalf. all payments as scheduled. your down payment of
% $ N/A $ N/A $ N/A $ N/A
YOUR PAYMENT SCHEDULE WILL BE:
NUMBER OF PAYMENTS AMOUNT OF EACH PAYMENT WHEN PAYMENTS ARE DUE
Beginning on __n/a__/____/____ and on the same day each
$ N/A (check one) __n/a___ weekly or __n/a___ bi-weekly thereafter
(Any late fee payments and conditions thereof must be disclosed on the enrollment agreement and in
All prices for program are printed herein. Contracts are not sold to a third party at any time. There are
no carrying charges, interest charges, or service charges connected or charged with any of these
programs unless stated.
CANCELLATION AND REFUND POLICY
Should a student’s enrollment be terminated or withdraw/cancel for any reason, all refunds will be
made according to the following refund policy:
1. Cancellation must be made in person or by Certified Mail
2. All monies will be refunded if the school does not accept the applicant, with the exception
of the registration fee.
3. If the student cancels before the first day of class this will result in a refund of all monies
paid, with the exception of the registration fee and book fee.
4. Cancellation after attendance has begun, but prior to 50% completion of the program, will
result in a pro-rated refund. Determined on the number of hours completed to the total
program hours (based on the clock hours). Registration fee, Supplies/CPR/First Aid, and
Book fee are non-refundable.
5. Withdrawal/Cancellation after completing 50% of the program will result in no refund.
6. Termination date: The termination date for refund computation purposes is the last date of
actual attendance by the student unless earlier written notice is received.
7. Refunds will be made within 30 days of termination or receipt of a Cancellation Notice.
8. A student can be terminated, at the discretion of the Director, for insufficient progress,
non-payment of costs, or failure to comply with the rules
Note: Special rules for refund or re-admittance apply to individuals called to active duty for
Page 2 of 3
GROUNDS FOR TERMINATION
A student’s enrollment can be terminated at the discretion of the institution for insufficient academic
progress, non-payment of academic costs, or failure to comply with rules and policies established
by the institution as outlined in the catalog and this agreement.
Although placement assistance may be offered, the institution does not guarantee employment.
This document and the catalog constitute a binding contract between the institution and the student
and no further modification or representation except as herein expressed by both parties will be
Upon satisfactory completion of the program the student will be awarded a certificate.
DO NOT SIGN THIS CONTRACT BEFORE YOU HAVE READ IT OR IF IT
CONTAINS ANY BLANK SPACES. ALL SIGNERS HAVE RECEIVED AND
READ A COPY OF THE BINDING DOCUMENT AND CATALOG.
_____________________________ ______ __________________________ _______
Signature of Applicant Date Signature of Parent/Guardian Date
(If under 18 years of age)
Signature of School Official Date
Page 3 of 3