Little Rock Enrollment

Please complete the form below, all fields are required. You will then be redirected to the payment options page.

* IMPORTANT *
Enrollment will not be complete until payment arrangements have been made.

For which term do you seek admission?*
Will you attend the Friday or Saturday weekly courses?*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Date of Birth*
Date Format: MM slash DD slash YYYY
Have you received your high school diploma or GED?*
How did you hear about Little Rock School of Dental Assisting?*
If applicable, who referred you to us?
Select Your Form of Payment*
Select Payment Option*
- $4,000 Paid in Full
- $500 Down Payment and $3,500 Due at Orientation
- $1,000 Down Payment and 3 Payments of $1000 due at the start of the 2nd, 4th and 6th class
Name of Cardholder who will be Paying (if not student)
E-Signature*
By signing below, the student agrees to pay Apex Dental Education the total stated tuition and fees. The school agrees to provide the dental assistant training in accordance with the provisions of the school’s curriculum outline. Payment of all monies due shall be a condition of continuing enrollment. Upon satisfactory completion of all academic and skill requirements and when all financial obligations to the school have been met, the school will award the Dental Assisting Certificate to the student. The student and school understand that this Enrollment Agreement, WHICH INCLUDES THE REFUND POLICY outlined in the Catalog, may not be amended except in writing and signed by both parties.

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