Healthcare Programs Sign-up Form

Policies

Please read through our policies before signing below.
Please Initial*
*By initialing, you authorize your understanding to the above statement.*
Payment

Once your sign-up is complete you will receive an email confirmation with a link to our payment website. You may pay for the course in full or select our Installment Plan. The Installment Plan allows participants to make payments of any amount and at any time until payment is paid in full. All payments must be paid in full before the course begins.

** These courses are approved by Workforce Solutions for Workforce Innovation & Opportunity Act (WIOA) financial funding. Please contact your local Workforce Solutions Office to see if you are eligible for this funding aid.**
Please select which form of payment you will be using.*

Self PayTexas Workforce Solution - WIOA FundingOther
Refund Policy

A refund may be made under these conditions:

1) A refund will be honored if requested at least one (1) business day prior to the program start date No refunds will be processed after that date.

To request a refund under these conditions, participants will need to email the Center for Continuing Education. Once the request has been made, refunds can take up to 4 weeks to be processed. Refunds will be sent to the original method of payment (card/bank acct.).

2) A 100% refund will be given for classes/programs that were cancelled by the Center for Continuing Education.
Model Release Form (Not Required)

I hereby grant permission to Texas A&M University-Kingsville, of 700 University Blvd, city of Kingsville, state of Texas, its legal representatives, assigns and those acting under its authority, to copyright, publish and use in all forms and media and all manners for advertising, trade, promotion, exhibition or any other lawful purpose whatsoever, still, single, multiple or moving photographic portraits or pictures of me in which I may be included in whole or in part, or composite or changed in character, or form, in conjunction with my own or a fictitious name, or reproductions thereof in color or otherwise or other derivative works made through any medium. I hereby waive the right to inspect the finished product that may be used in connection therewith or the use to which it may be applied. I do hereby warrant that I am of full age and have every right to contract in my own name in the above regard.

Further, I have read the above authorization and release, prior to its execution, and I am fully familiar with the contents thereof.
Electronic Signature for Model Release

Clear
By signing, you agree to the above statement.
Please Initial*
*By initialing, you authorize your understanding to the above statement.*
Model Release*

I consentI do not consent
Full Name

First NameMiddle NameLast Name
Statement of Responsibilities

By signing, I agree to all Terms and Conditions. I am aware that I am responsible for all program fees associated with the submission of this registration form. I understand that the participant registration to this program will be considered incomplete until my balance has been paid in full or an approved payment plan has been established with the Center for Continuing Education.
Full Name*

First NameMiddle NameLast Name
Electronic Signature*

Clear
By signing, you agree to the above statement.
By submitting this form, I verify that all information submitted is correct and to the best of my knowledge. I have read and agree to abide by the policies listed on this application, along with all the departmental policies through the Center for Continuing Education. Departmental policies can be found on our website.

After you have submitted your Sign-Up Form, you will be redirected to the Medical Waiver. Once you have completed the Medical Waiver, you will be redirected to eMarkets (online payment system) to make full payment of the course(s) you have signed-up for.

The default method of contact to participants is through the email address submitted on this sing-up form unless indicated differently on the perferred method of contact.

Thank you for sign-up for our program(s) and we look forward to having you this semester!

Primary Contact:

Center for Continuing Education
Front Office
Cousins Hall, RM 108
361-593-4261
conted@tamuk.edu
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Healthcare Programs Information

Healthcare Program Sign-Up Form

Participant's Information

Healthcare Program Selection

Policies

Statement of Responsibilities