6685 Peachtree Industrial Blvd.
Atlanta, GA-USA 30360
P. 1-877-503-4599 F. 1-678-387-5289
ENROLLMENT AGREEMENT (Revised 04/10)
Student Information Parent / Guardian Information
Name: Full Name:
Date of Birth: Address:
Gender: Male Female City:
Social Security Number: State:
Day Phone #:
City: Evening Phone #:
State: Email Address:
Day Phone #:
Evening Phone #:
High School Diploma Program (9th through 12th)
- Transcript Received
- Transcript Pending
Credit Recovery Program
Payment Information - Personal Payment Information - Card Details
Name of Cardholder: Initial Payment:
Or Bank Account holder Recurring Monthly Payment:
Billing Address: o Payment Type:
State: Bank Name:
Zip: Account # :
Country: ABA Routing #:
Day Phone #: Debit/Credit Card
Evening Phone #: Card #:
Email Address: Exp. Date:
Card Type: Visa MasterCard
Discover American Express
o I authorize recurring monthly charge - To be charged each
following month on the:
5th - If enrolled by 10th
15th - If enrolled between 11th & 20th
Cardholder’s Signature: 25th - If enrolled between 21st & 24th
5th of 2nd following month - If enrolled between 25th & 31st
until completion of the program.
Name of Admissions Executive: Date:
Source of Referral:
This contract correctly sets forth the entire agreement between the student, parent and/or guardian. No agreement or understandings shall be binding on either
of the parties hereto unless specifically set forth in this contract or subscribed to by the parties hereto in writing.
DIPLOMA and TRANSCRIPTS:
Upon satisfactory completion of a program of study and/or graduation requirements, the student is issued a Diploma in recognition of graduation and/or a
transcript reflecting the credits attempted and completed. The school may withhold a student’s diploma and/or transcripts until the student has fulfilled his/her
financial obligation to the school.
National High School is in compliance with all requirements imposed by or pursuant to Title VI of the Civil Rights Act of 1964 and section 504, Rehabilitation
Act of 1973. National High School does not discriminate on the basis of race, color, religion, sex, or national origin in its activities, programs, or employment
policies, in accordance with Federal, State, and local laws.
National High School observes FERPA, the Family Educational Rights and Privacy Act.
All instruction is conducted in English. International students will be required to pay postage costs for mailings which are requested by the student.
A student is enrolled into National High School’s program by paying a registration fee of $150. The administrative department requires up to seven (7)
business days to setup a student’s virtual environment. The applicant or parent hereby agrees to make acceptable payment arrangements with National High
School based upon individual circumstances and enrollment date. These arrangements may include: Credit Card (Mastercard, VISA, American Express, and
Discover); Check, Cashier’s Check, Bank wire, Money Order; and/or Non-Federal Student Loans. By agreeing to these terms and conditions, National High
School is authorized to charge your credit card or Bank Account $150 monthly until the program is completed or until the student opts to withdraw from the
program. If a payment is not made on the due date, the individual is subject to a $50 late fee.
The student understands that there is a seven (7) day administrative period once enrolled into the program, in which time the IT department and the Student
Services Department work to set up the virtual learn center. Upon completion of any given assignment or exam, the academic department scores all submitted
materials within seven (7) to ten (10) business days. The student is considered completed ONLY when all grades for assignments and exams have been posted
to the course. Students will maintain their student status until that period and are fully responsible for all financial obligations. If the student formally
withdraws or ceases to meet their financial obligation, grade report and transcripts will not be issued.
ARBITRATION: The parties agree to submit any disputes arising from this agreement to final and binding arbitration under the Rules of the American
REFUND AND WITHDRAWAL POLICY: If a student cancels within 3 calendar days after midnight of the day the student enrolls (for this purpose
the date of initial payment is considered the date of enrollment), the student will receive a FULL refund with NO further obligation. Thereafter the
initial payment of $150 is non-refundable. Subsequently, a student may withdraw at any time during the course of program. If the intent to withdraw is not
conveyed to the Administrative Department by filling out a Status Change/Withdrawal Form at least 5 days before the payment due date, the student will be
liable to pay tuition for that month. Any refunds due will be processed within 30 days.
FTC DISCLOSURE STATEMENT: NOTICE: ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS
AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT
HERETO OR WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY
THE DEBTOR HEREUNDER.
Student Name: Signature: Date:
Parent Name: Signature: Date: