Registration Process

Register for Course

Reserve a Seat

Complete Enrollment

ARIZONA

Enrollment Agreement

Please complete the form below, all fields are required.

Enrollment Agreement Location:

Semester Enrollment

Preferred class attendance day

Class attendance day preference is not guaranteed and is subject to availability. Please contact us for questions.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth

YYYY

Scrub Size

Please select the size of the scrubs the school will issue at orientation and collect at the end of the course.

Select Your Form of Payment

Select Payment Option

$5950 Paid in Full

$500 Down Payment and $5450 Due on first day of class

$950 Down Payment and 4 Payments of $1250 due every other week starting on Week 1

Name of Cardholder who will be Paying (if not student)

Student Acknowledgements (initial)

Holder in Due Course Statement: 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 (FTC Rule effective 5-14-76). The Student Understands: 1. The School does not accept credit for previous education, training, work experience (experimental learning), or CLEP. 2. The School does not guarantee job placement to graduates upon program/course completion or upon graduation. 3. The School reserves the right to reschedule the program start date when the number of students scheduled is too small. 4. The School will not be responsible for any statement of policy or procedure that does not appear in the School catalog. 5. The School reserves the right to discontinue the student’s training for unsatisfactory progress, nonpayment of tuition or failure to abide by School rules 6. Transfer of Credits - It should not be assumed that any programs described in the School catalog could be transferred to another institution. The School does not guarantee the transferability of credits to a college, university or institution. Any decision on the comparability, appropriateness and applicability of credits and whether they should be accepted is the decision of the receiving institution. 7. This document does not constitute a binding agreement until accepted in writing by all parties.

Acknowledgement of Receipt of School Catalog

I hereby acknowledge receipt of the School’s catalog, which contains information describing programs offered, and equipment/supplies provided. The School’s catalog is included as a part of this enrollment agreement, and I acknowledge that I have received a copy of this catalog.

Acknowledgement of Enrollment Agreement

Also, I have carefully read and received an exact copy of this enrollment agreement.

Termination of Enrollment

I understand that the School may terminate my enrollment if I fail to comply with attendance, academic and financial requirement or if I disrupt the normal activities of the School. While enrolled in the School. I understand that I must maintain Satisfactory Academic Progress as described in the School catalog and that my financial obligation to the School must be paid in full before a certificate may be awarded. I also understand that this institution does not guarantee job placement to graduates upon program/course completion or upon graduation.

Contract Acceptance

I, the undersigned, have read and understand this agreement and acknowledge receipt of a copy. It is further understood and agreed that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the School Official. I also understand that if I default upon this agreement, I will be responsible for payment of any collection fees or attorney fees incurred by Apex Dental Education. My signature below signifies that I have read and understand all aspects of this agreement and do recognize my legal responsibilities in regard to this contract. (E-Signature)

Photo Release

I grant to Apex Dental Education Network, its representatives and employees the right to take photographs of me and my property in connection with the above-identified subject. I authorize Apex Dental Education Network, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Apex Dental Education Network may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

Yes