Source Institute of Massage Therapy & Bodywork, LLC by 0n9axIhb

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									          Northwest Florida School of Massage Therapy & Bodywork, LLC
                       1031 A W 23rd Street, Panama City, FL 32405. Phone: 850 530 1598
                                              Enrollment Agreement

Last Name:
First Name:
Address:
Phone No:
E-Mail:
DOB:

In consideration of my acceptance as a student for the Massage Therapy Program as of the above date, I hereby enroll in
Source Institute of Massage Therapy & Bodywork, LLC and obligate myself to pay to the order of Source Institute of
Massage Therapy & Bodywork, LLC $5,400.00 (Five Thousand Four Dollars) to be paid upon entrance or as arranged
with the business office. I understand that if for any reason I am unable to enter Source Institute of Massage Therapy &
Bodywork, LLC., all tuition paid prior to entrance (with the exception of a $ 150.00 registration fee) will be refunded.
Although the school will provide technical assistance to me in obtaining tuition assistance, I understand that it is my
responsibility to apply for all appropriate tuition assistance. Tuition assistance is subject to change based on income and
student status and must be re-applied for each fiscal year in which I attend school. I hereby authorize Source Institute of
Massage Therapy & Bodywork LLC to apply any funds which I am entitled to receive from financial aid sources as a
credit to my account for registration, tuition, books and other educational expenses.
Our retail installment contract is a part of this document for any student utilizing any of our private tuition funding
options.

Contracts with faculty staff and other support services are made on this basis. Expense involving these obligations does
not diminish when students are absent, withdraw or are dismissed. Therefore, when a student discontinues for any reason,
the REFUND POLICY AS PRINTED ON PAGE 2 OF THIS DOCUMENT WILL APPLY.

Source Institute of Massage Therapy & Bodywork LLC reserves the right to make photocopies of all student work and to
use such copies in promotional programs. Changes may be made to the program of study as necessitated by changes in
business needs for the purpose of satisfying such needs and increasing the skill level of students.

Each student is accepted with the understanding that he/she is registered/obligated for the entire program which consist of
525 classroom hours. Tuition fee is $5,400.00. This does not include a one time non refundable $150.00 registration fee.
Students wanting a refill of lotion from Source Institute will pay $4.00 for an 8oz refill. Students are responsible for
bringing three sets of twin sheets, three pillow cases and one small blanket for massage practice and clinic. NOTE:
Successful completion of this course is based on clock hours. Students must maintain a passing grade and complete
525 clock hours in order to receive a diploma.

Massage Classes end approximately one year from the start date for part time classes and six months from the start date
for full time classes. The anticipated completion date of your program will be on _______________. This date may be
altered due to unforeseen circumstances of which Source Institute has no control (i.e. Hurricanes, Flooding, etc.).

Employment placement services: The extent of placement services shall be specifically described. No guarantee of
placement shall be made or implied. Source Institute may disclose information relating to market and job availability, if
verified through statistical research; however, Source Institute shall not promise or imply any specific market or job
availability amounts.




                                                          Page 1 of 3
                                        Cancellation and Refund Policy of
                             Source Institute of Massage Therapy & Bodywork, LLC.

         Should the student be terminated or cancel for any reason, all refunds will be made according to the following
refund policy.
         All monies paid by the prospective student will be refunded if requested within 3 business days after signing a
Certificate of Enrollment, or if no Certificate of Enrollment is signed, after first making a payment to the institution.
Students who have not visited the school facility prior to enrollment will have the opportunity to withdraw without
penalty within three business days following either attendance at a regularly scheduled orientation or following a tour of
the school facilities and inspection of equipment.
         After 3 business days, all tuition paid prior to entrance (with the exception of the registration fee ) will be
refunded.
         Cancellation after attendance has begun, but prior to completion of forty percent (40%) of the student’s program
of study, will result in a pro rated refund equal to the portion of the period of enrollment for which the student has been
charged that remains on the last day of attendance, rounded downward to the nearest percent of that period. Cancellation
after completing forty percent (40%) of the program will result in no refund. The termination date for refund purposes is
the student’s last date of actual attendance (LDA). Refunds will be made within 30 days of the institution’s notification or
determination that the student will not return.
         A student may voluntarily withdraw by signed written notice to the school director. A student may be dismissed
from school, at the discretion of the director, for non-payment of tuition fees, poor attendance, failure to meet academic
standards, misconduct, and/or violation of the policies outlined in the school’s catalog. In case of a prolonged illness,
accident, death in the family or other extreme circumstance beyond the control of the student, the School will decide an
agreement with the student which is reasonable and fair to both the student and the institution.
                                                         Repetition Fees
The tuition amounts stated above allow for each course to be taken once. Any student needing to repeat a course due to
failure, withdrawal, or incomplete work, will be charged an additional amount equal to the normal cost of such course as
taken as a short course.
                                                         Payment Plans
         For students utilizing institutional payment plans with four or more payment installations, the following “ Five
Federal Boxes “ apply and must be completed as an integral part of this document.

                                                        Five Federal Boxes
        ANNUAL PERCENTAGE RATE             FINANCE CHARGE             Amount Financed: The          Total       of    Total Sales Price:
                                                                      dollar amount the credit      Payment: The      The total cost of your
                                                                      provided to you or on         amount you        purchase on credit
                                                                      your behalf.                  will have paid    including your down
                                                                                                    after you have    payment of
                                                                                                    made        all
                                                                                                    payments as
                                                                                                    scheduled.
                                  %        $                          $                             $                 $   0


        YOUR PAYMENT SCHEDULE WILL
        BE:

                                           Amount of each
        Number of payments                 payment                                   When payments are due

                                                                      Beginning ________________________ and on the same day of
                                           $                          each month thereafter.



                                      Source Institute of Massage Therapy & Bodywork LLC ID# 3720
                                                          Page 2 of 3


        I certify that I HAVE RECEIVED AND READ A COPY OF THIS ENROLLMENT AGREEMENT AND
CATALOG which contains: My program outline, schedule of tuition, books, fees, and other charges, refund policy,
regulations pertaining to rules of operation and conduct, grading policy, satisfactory progress standards, placement,
assistance and general information. I further certify I HAVE RECEIVED AND READ A COPY OF THIS
ENROLLMENT AGREEMENT during my period of enrollment in Source Institute of Massage Therapy & Bodywork,
LLC, and that violations of these policies will be met with appropriate disciplinary actions including expulsion. I
understand that this document along with the catalog shall be a binding agreement.
Other Comments:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________

Entrance Date

Day Classes                                               Night Classes                                     Part Time

Class Days:     M T     W TH F       SA                                 Class Meeting Times:        to

Tuition Period Covered:                                                 From             to



Do you have a high school diploma?     YES     NO

Do you have a GED?        YES   NO

High School attended:




Important! If you are utilizing any non-governmental financial aid and are required to make more than four (4)
installments, there is a separate “Installment Promissory Note with Disclosure” that is a part of this Enrollment
Agreement.
                 This agreement is not effective until accepted in writing by the Director of the school, and signed and
dated by the student. If not accepted by the Director, all funds paid to the school for the period covered under this
agreement shall be refunded.



Student Signature   ________________________________________________Date ___________________

Guardian Signature ________________________________________________Date ___________________

Institution Approval _______________________________________________ Date ___________________


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