STUDENT ENROLLMENT AGREEMENT



STUDENT ENROLLMENT AGREEMENTTHIS AGREEMENT, TOGETHER WITH THE PROGRAM DESCRIPTION OF THE COACHING CERTIFICATION COURSE BECOMES A BINDING AGREEMENT.READ APPLICATION THOROUGHLY BEFORE ANSWERING QUESTIONSStudent InformationName:Date:Address: Street Address City/State ZIP/Postal CodeName of Parent/Guardian (If student is under 18): Telephone: (Home): (Business or Cellular): Social Date CircleSecurity Number: of Birth: One: Male FemaleProgram InformationProgram Title:Length: Clock Hours:Class Schedule: ( ) Full Time ( ) Part Time ( ) Day Classes ( ) Evening ClassesHours per Week: Start Date: / / / Ending Date: / / / Tuition: $Registration Fee$Books & Materials$Other Costs$Total Program Price$This agreement constitutes a binding Contract between the Student and NEURO STRATEGIC COACHING INSTITUTEMethods of Payment[ ] Full payment at time of signing enrollment agreement.[ ] Registration fee at the time of signing enrollment agreement with balance paid prior to starting date.[ ] Registration fee at time of signing enrollment agreement with balance paid prior to graduation by a payment plan.Cancellation and Refund Policy:Should a student’s enrollment be terminated or cancelled for any reason, all refunds will be made according to the following refund schedule:?Cancellation can be made in person, by electronic mail, by Certified Mail or by termination.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 (3) business day, but before the first class, results in a refund of all monies paid, except for the registration fee.Cancellation after attendance has begun, but prior to 40% completion of the program, will result in a Pro Rata refund computed on the number of hours completed to the total program hours.Cancellation after completing 40% of the program will result in no refund.Termination Date. In calculating the refund due to a student, the last date of actual attendance by the student is used in the calculation unless earlier written notice is received. Refunds will be made within 30 days of termination of student’s enrollment or receipt of Cancellation Notice from student.A student’s enrollment can be terminated at the discretion of the governing board of the school for insufficient academic progress, non-payment of academic costs, or failure to comply with rules.GROUNDS FOR TERMINATIONI agree to comply with the rules and policies and understand that the School shall have the right to terminate this contract and my enrollment at any time for violation of rules and policies as outlined in the catalog. I understand that the School reserves the right to modify the rules and regulation, and that I will be advised of all modifications.GRADUATION REQUIREMENTSI understand that to graduate from the program and to receive a diploma, I must successfully complete the required number of scheduled clock hours as specified in the catalog description of the program and on the Student Enrollment Agreement, pass all written and practical examination with a 70% average, complete all mentor, and 1-to1 student peer coaching calls, and satisfy all financial obligations to the School.EMPLOYMENT ASSISTANCEI understand that the School has not made and will not make any guarantees of employment or salary upon my graduation. The School will provide me with placement assistance, which will consist of identifying employment opportunities and advising me on appropriate means of attempting to realize these opportunities.ACKNOWLEDGEMENTThis contract contains the entire agreement between the School and myself, and no further modifications or representations except as herein expressed in writing will be recognized.NOTICE TO PROSPECTIVE STUDENTS: 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 OR COURSE PROGRAM DESCRIPTION.Signature of ApplicantDateSignature of Parent/Guardian DateSignature of School Official DatePayment may be made by bank wire to WELLS FARGO, payable to CCI Coaching Institute, Account # 2000034693504, ABA Routing #063107513; SWIFT CODE: WFBIUS6S or can be made (see attached Permission to Charge Account for credit card payment). Permission to Charge AccountPlease complete the information requested below for credit card payment.I hereby give NSCI Coaching Institute permission to charge my credit card in the amount of $___________ in total for cash payment. Otherwise, the client shall pay half of the agreed upon amount and the remaining balance shall be divided in monthly payments, payable on the first day of every month beginning __________,until the balance is payed in full. Payee for credit card purposes will show payee as CCI.Credit Card Service Provider: MC ______ VISA ______ AMEX ______Name, as it appears on the card: ___________________________________________Address of location to which statement is mailed, including zip code: ________________________________________ ________________________________________Acct #:_______________________________________________Verification # ____________Expiration Date ______________________The signature on this agreement indicates full compliance with the above information and complete understanding of the services provided.______________________________________________________________________Signature (Client)DateThank youMario Garcia, Jr., Ph.D., J.D., PCC, BCCPresidentNeuro Strategic Coaching Institute ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download