HIFE College Coaching Program Enrollment Application

Full HIFE College Coaching Program Enrollment Form
Please complete as much of the information as possible. This will provide the HIFE Coach the necessary information needed to best understand the student and family situation.
Date Enrolled*

MonthDayYear
Today's Date
Section 1: Student's Information
Student's First Name*
Student's Middle Name
Student's Last Name*
Do you go by a different name/nickname?
Student's Email Address*
Student's Gender
Student's Date of Birth

MonthDayYear
Date
Student's Resident Status
Student's Address
Student's Suite/Apt Number
Student's City
Student's State/Province
Student's Zip/Postal Code
Student's Home Phone Number

Area CodePhone Number
Student's Mobile Phone Number

Area CodePhone Number
Best Time to Call
Best Phone Number to Call

Area CodePhone Number
Student's Employer
School Attending
Student's Grade Level
Student's School Level
Current GPA
Class Rank
Year Student Will Graduate High School
SAT Critical Reading
SAT Math
SAT Writing
ACT Composite
ACT Math
ACT English

Section 2: Student's Background and Educational Goals

Please provide as much information as possible otherwise there may be a delay in assigning a coach.
Scholastic Achievements*
Fields of Interest*
Jobs (Where are you currently working? Where have you worked recently?)*
Sports*
Community Service*
Intended Colleges (colleges of interest)*
Educational Goals (type of degree, knowledge or skills desired, other educational goals) *
Occupational Goals (career desired, etc.)*
Notes

Section 3: Parent Information
Father First Name
Father Middle Name
Father Last Name
Father Address
Father Suite/Apt Number
Father City
Father State/Province
Father Zip/Postal Code
Father Home Phone

Area CodePhone Number
Father Mobile Phone:

Area CodePhone Number
Father Email Address*
Father Employer
Father Position
Mother First Name
Mother Middle Name
Mother Last Name
Mother Address
Mother Suite/Apt Number
Mother City
Mother State/Province
Mother Zip/Postal Code
Mother Home Phone

Area CodePhone Number
Mother Mobile Phone

Area CodePhone Number
Mother Email Address
Mother Employer
Mother Position

Did a Consultant assist with this enrollment?

YesNo
Section 4: Consultant Information
Writing/Primary Consultant's Name*
Primary Consultant's HIFE Email*
NOTE: THE PRIMARY CONSULTANT MUST ENTER A VALID HIFE EMAIL ADDRESS ABOVE BEFORE SUBMITTING THIS FORM. PERSONAL OR WORK EMAILS WILL NOT BE ACCEPTED
Primary Consultant's Agent Code #*
Primary Consultant's Phone Number*

Area CodePhone Number
Upline SMD:
Upline CEO:
Primary Consultant's Office Address
Primary Consultant's Financial Center*
2nd/Split Consultant's Name:
2nd Consultant's HIFE Email
2nd Consultant's Agent Code #
2nd Consultant's Phone Number

Area CodePhone Number

The Heartland Institute Pledge
Through our “College Planning” guidance and preparation for a successful college education, the Heartland Institute of Financial Education commits to provide “excellence in guidance” for the following areas:
- HIFE College Preparation Assistance – Offers specific areas of progress that are required to prepare the student during each level of high school, from the beginning of the Freshman year through the Senior year. Specific items for completion, expectations, examples and time requirements are included.
- HIFE College Planning Tasks with Timeline – Coordinates timing and dates with the College Preparation tasks to provide the student with an effective process for listing and managing expected items of completion during each and every year throughout the high school years.
- HIFE College Visitation Suggestions – Provides a list of relevant questions for families and students to ask during college visits. This list helps to prioritize colleges for final consideration and ultimate choice.
- HIFE SAT/ACT Testing Preparation and Guidance – Guides the student to adequately prepare for the required testing for college acceptance, through access to study material and actual practice exams.
- HIFE College Admissions Guidance – Aids the student and family by organizing a successful admissions campaign, which provides assistance to the family in selecting schools to apply for and assisting in completing admissions applications.
- HIFE Scholarship Search and Guidance – Provides the student and family with the necessary tools to conduct a local scholarship search and Internet access to a complimentary national database through the HIFE web site.
- HIFE Expected Family Contribution (EFC) Guidance – Explains and provides guidance to reduce the EFC to the lowest achievable level.
- HIFE Financial Aid Guidance – Assists student and family with completion of the Federal and institutional financial aid forms, which will help make certain the student applies for all available financial aid.
- HIFE Negotiation Strategy – Positions your student for the most financial aid possible, through a series of highly effective strategies and planning techniques.
- HIFE College Transition Assistance – Assists the student with adapting to college life and how to deal with the differences between high school and college
- HIFE College Completion Assistance – Guides the student through the course selection and focusing on completing their major.
- HIFE Transition to Work/Grad School – Assists student with resume preparation, job shadowing and internships including interviewing techniques.
This membership agreement constitutes the services provided and is designed to meet the college planning needs of each student through a combination of one or more of the specific sources and services listed. All strategies and techniques are the property of the Heartland Institute of Financial Education and are intended for the sole use of the parties named on the face of this service agreement. HIFE is not in the business of rendering legal or tax advice. Strategies suggested are based on information provided by each student and family, which remains confidential.
HIFE Pledge

The primary role of the Heartland Institute of Financial Education is to assist the student and family with the college preparation, college application and financial aid process, as well as provide the guidance to complete these steps. HIFE may disclose strategies that may reduce the Expected Family contribution (EFC) and/or find sources of other funds and/or find other ways of reducing the out of pocket expenses.. The success of these strategies is dependent upon a 100% commitment of the family to implement.
The HIFE Pledge is reviewed regularly. In addition, the work effort contributed by the student is critical to the success of this program. The Student confirms the pledge and the parent agrees to support the student in this endeavor.
HIFE will assist each student with financial aid forms, college profiles, financial aid, SAT/ACT test preparation, scholarships, grants, loans and all other items, which are represented in “The Heartland Institute Pledge” above.
IMPORTANT NOTE ON SCHOLARSHIPS AND GRANTS:

Since financial aid and all scholarships are managed and distributed by a grantor (such as the federal or state government, foundations, associations, corporate sponsors or colleges/universities) the Heartland Institute of Financial Education cannot guarantee that scholarships or grants will be awarded to any student.

However, our coaches will work diligently to provide each student with opportunities to apply for scholarships and grants that are applicable to them.
By clicking "I agree" below, I acknowledge that I have read the HIFE Pledge and the information regarding scholarships and grants. I understand that HIFE does not guarantee that scholarships or grants will be awarded to the student named in this application:*

I agree.

Student/Family Pledge
THE HEARTLAND INSTITUTE OF FINANCIAL EDUCATION (HIFE) SERVICE AGREEMENT INCLUDES THESE BASIC REQUIREMENTS:
1. Each student must enroll/be enrolled at a post-secondary institution of higher education that meets the required federal guidelines. Additionally, the educational institution must qualify to participate in federal programs including PELL and all Federal Higher Education Act programs. Each student must be a U.S. Citizen or eligible non-citizen with required registration.
2. Financial aid funding must be used for the cost of education during the academic year. The cost of Education is determined by each college or university and will include tuition and fees, room and board, books, supplies, and an allowance for transportation and certain personal expenses
3. Each student must achieve a minimum of halftime enrollment as a regular student and must meet the Satisfactory Academic Standards set by the specific school. Each student must file all forms required by school, lender, and HIFE and answer correspondence in a timely manner. Current annual dues must be maintained.
4. Each student must commit to doing their part by completing assigned paperwork and tasks necessary to prepare themselves to gain admittance to the appropriate college and/or university.
Parents/Student Responsibilities:

1. Complete 100% of the applicable scholarship applications they are given by the coach.

2. Complete the assessment testing as required by the coach.

3. Apply to at least 3 colleges.*

4. Complete all other assignments the coach assigns.
*When effectively utilizing HIFE’s detailed financial strategies and planning methods, we know that at least three (3) colleges and/or universities must be selected for student application purposes. This will provide the greatest possible outcome for the student.

Payment Information
The Heartland Institute of Financial Education will provide the above services for enrolled parents and students for a one-time Non- Refundable fee $2,695.00 for each student the first year with annual dues of $650.00 (subject to change) starting year 2 (see additional information below). HIFE is a 501(c)(3) non-profit entity.
There are three payment options for the initial enrollment fee:

Option A: One full payment of $2,695
Option B: $999 down payment, then $199 per month for 9 consecutive months ($2,790 total)*
Option C: $285 per month for 10 consecutive months ($2,850 total)*

*If you choose Option B or C, please note that payments will be processed to your credit card on the same daay each month based on the date of your initial order.
Upon submission of this form you will be directed to the payment site where you can select your preferred option and make payment with a credit card.

If you would like to pay by check instead (for the full payment of $2,695 ONLY), please CLICK HERE to download the payment authorization form. Send the authorization form along with the check to the address listed on the payment form. MAKE SURE TO COME BACK TO THIS WINDOW TO SUBMIT THE ENROLLMENT FORM.

If you have any questions regarding payment, please email accounting@hife-usa.org or call us at 303-597-0197.
How will you pay the enrollment fee (i.e. CREDIT CARD or CHECK)*
Remember, checks can be accepted for the full payment of $2,695 ONLY.
Late Fees, Reinstatement Fees & Annual Renewal Information
A late fee of $20 may be assessed if your credit card is declined and your payment is more than 15 days past due (this applies to payments for the initial enrollment fee and any subsequent renewals).

If you leave the program at any time, and wish to re-enter at a later date, a reinstatement fee of $150 may also be assessed.

A renewal fee is required each year that you wish to continue with the College Coaching Program after the first year. The current annual renewal fee is $500. However, HIFE reserves the right to change the renewal fee at any time. Note that any changes will apply to ALL students in the program, even if enrolled under the former rate, and you will be invoiced at the new rate when your next renewal is due.

Note that annual renewal fees WILL NOT BE CHARGED AUTOMATICALLY even if a payment plan is chosen for the initial enrollment fee. Invoices will be sent to all email addresses provided in this enrollment application with instructions on how to pay the renewal fee.
HIFE Refund Policy
Thank you for your support of our mission! However, the Heartland Institute of Financial Education has a NO-REFUND policy. As such, all sales are FINAL. This applies to the initial enrollment fee (whether you choose the full payment or a payment plan) and any subsequent renewals.
HIFE Cancellation Policy
You can cancel services provided by the Heartland Institute of Financial Education (HIFE) at any time.

In order to cancel, written notice must be provided to the Heartland Institute. Emails are an acceptable form of cancellation and you can send your notice to accounting@hife-usa.org. Please allow 1-2 business days for your cancellation to be processed.

Note that you must cancel services in writing at least five business days before the next scheduled payment (if on a payment plan) to avoid being charged for the next month’s fee.

All payments made to HIFE (including payments made in-full) before we have received your request to cancel are non-refundable.
I agree to HIFE"s Refund and Cancellation Policies.

I agree.
As the cardholder, by selecting "I agree" above, I signify that I have read and agree to the terms of HIFE's Refund and Cancellation Policies.

Payment Authorization
By signing this form below, I am providing my authorization to the Heartland Institute of Financial Education (HIFE) to charge my credit card according to the payment option I choose on the payment site (whether I choose a full payment or one of the payment plans as outlined above). This applies whether I am paying for myself or another party. The authorization also applies if I choose to make a full payment by check.
This payment authorization is to remain in full force and effect until I notify HIFE by sending written notice in such time and such manner to allow HIFE a reasonable opportunity to act on it.

I agree to notify HIFE of any changes in my account information at least 5 business days prior to the next billing date.
I understand that if my credit card is declined, HIFE may, at its discretion, try to reprocess the charge again within the next 15 days.

I also understand that a late fee of $20 may be assessed if my card is declined and the balance due is outstanding for more than 15 days.
A reinstatement fee of $150 may also be assessed if I leave the program and wish to rejoin the program at a later date.

I certify that I am an authorized user of the credit card used for payment on the payment site.
If you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to process the payment as a check transaction.
When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day you make your payment, and you will not receive your check back from your financial institution.
For annual renewals, I agree to pay the renewal fee that is in effect at the time I renew.

I also certify that I have read, and agree to, the HIFE Refund and Cancellation Policies.
Payer's First and Last Name*
Email*
Payer's Signature*
*By typing my name into the box above, I signify that I have read, and agree to, the payment terms outlined, including the refund and cancellation policies. This acts as a written signature and is binding in terms of the payment agreement.

Enrollment Agreement Authorization
By signing your name below, you agree to the above stated requirements and confirm that you have read and understand this entire agreement and privacy policy; you also signify that you have read and agree to the terms of the payment, refund and cancellation policies.
Student's Signature*
Father's Signature
Mother's Signature
Writing/Primary Consultant's Signature*
2nd/Split Consultant's Signature

PRIVACY POLICY NOTICE
The Heartland Institute of Financial Education (HIFE) strongly believes in protecting the confidentiality and security of information we collect about you. This Notice refers to The Heartland Institute (HIFE) by using the terms “us”, “we” or “our”. This Notice describes our Privacy Policy and describes how we treat the (Information) we receive about you.
Why We Collect and How We Use Information: We collect and use Information for business purposes with respect to our business relationships involving you. These business purposes include processing transactions requested by you.
How We Collect Information: We get most Information directly from you. The Information that you give us when applying for our services generally provides the Information we need. If we need to verify Information or need additional Information, we may obtain Information from third parties.
How We Protect Information: We treat Information in a confidential manner. Our employees and associates acting on our behalf are required to protect the confidentiality of Information by complying with all confidentiality policies and applicable rules, regulations and statutes. Employees and associates may access Information only when there is an appropriate reason to do so, such as to administer or offer our products or services.
Information Disclosure: We may disclose any Information we believe is necessary for the conduct of our business, or where disclosure is required by law. For example, Information may be disclosed to others to enable them to provide business services for us, such as performing general administrative activities for us and assisting us in processing a transaction requested by you. Information may also be disclosed for audit or research purposes; or to law enforcement and regulatory agencies, for example, to help us prevent fraud. Information may be disclosed to others that are outside of HIFE, such as companies that process data for us or companies that provide general administrative services for us. We may make other disclosures of Information as permitted by law.

We do not make any other disclosures of Information to other companies who may want to sell their products or services to you. For example, we will not sell your name to a catalog company. In the unlikely event there were to be a change in this fundamental policy that would permit additional disclosures of your confidential Information, we will provide written notice to you and you will be given an opportunity to direct us as to whether such disclosure is permissible.
Access to and Correction of Information: Generally, upon your written request, we will make available information for your review. Information collected in connection with, or in anticipation of, any claim or legal proceeding will not be made available. If you notify us that the Information is incorrect, we will review it. If we agree, we will correct our records. If we do not agree, you may submit a short statement of dispute, which we will include in any further disclosure of Information.
Further Information: In addition to any other Privacy Policy Notice we may provide, a recently enacted federal law established new privacy standards and requires us to provide this summary of our Privacy Policy. You may have additional rights under other applicable laws. For additional information regarding our Privacy Policy, please write to us at 8301 E. Prentice Avenue, Suite 312, Greenwood Village, CO 80111.
BEFORE SUBMITTING THIS FORM, PLEASE BE SURE THAT ALL INFORMATION HAS BEEN ENTERED AND IS CORRECT. YOU CANNOT EDIT OR CHANGE ANYTHING AFTER THE FORM HAS BEEN SUBMITTED.
IF YOU DO NOT SEE THE 'SUBMIT' BUTTON BELOW, PLEASE VERIFY THAT A VALID HIFE EMAIL ADDRESS HAS BEEN ENTERED FOR THE PRIMARY CONSULTANT.
ONCE YOU CLICK ON 'SUBMIT', PLEASE KEEP YOUR BROWSER OPEN SO THAT YOU WILL BE REDIRECTED TO THE PAYMENT SITE.
Should be Empty:

Full HIFE College Coaching Program Enrollment Form

Section 1: Student's Information

Section 2: Student's Background and Educational Goals

Section 3: Parent Information

Section 4: Consultant Information

The Heartland Institute Pledge

Student/Family Pledge

Payment Information

Late Fees, Reinstatement Fees & Annual Renewal Information

HIFE Refund Policy

HIFE Cancellation Policy

Payment Authorization

Enrollment Agreement Authorization

PRIVACY POLICY NOTICE