H.E.A.R.T Academy ENROLLMENT AGREEMENT

H.E.A.R.T Academy Enrollment Agreement
The H.E.A.R.T Academy, LLC

11832 Newcastle Ave. Suite 17 Baton Rouge, LA. 70816 225-627-3299 Email: marsharae@theheartacademyllc.com
Student Name *

Student First Name Student Last Name
Age *
Date of Birth *
ex: 01/01/2022
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *
Please enter a valid phone number.
Last Four Digits of SS#: *
Date *
ex: 01/01/2022
High School Completion *

YES NO
Name of Program *
Program Length (Hours) *
The above listed school and student enter into agreement under which the student will pay tuition and fees as indicated below as well as attest to receiving a copy of the school’s rules and regulations (program outline, schedule of tuition, fees, and other charges, the refund policy, rules of operation and conduct, grading policy, description of job placement assistance and general information) as set forth in the school catalog.
In consideration my acceptance as a student for the blanks* program as of above date, I hereby enroll and obligate myself to pay the order of blank*
blank*, dollars ($ blank*) to be paid as follows: ($ blank*) with the signing this enrollment agreement and the balance of ($ blank*) to be paid as follows: ( blank*)
THREE-BUSINESS-DAY CONCELLATION If for any reason the student is unable to enter, all monies paid will be refunded if requested within three business days after signing an enrollment agreement and making an initial payment. Cancellation after the three-business-day cancellation period but before commencement of classes by the student: 1. Cancellation must be made in writing, either in person or by mail. 2. Tuition or fees collected in advance of entrance and if the student does not begin classes, all monies will be refunded minus the $150.00 registration fee. 3. Refunds for a student who does not begin classes shall be made within 30 days after receipt of cancellation notice.
WITHDRAWAL AFTER COMMENCEMENT OF CLASSES REFUND POLICY SHALL BE: 1. After a student has completed less than 15% of the course, the institution shall refund at least 80% of the tuition, less the registration fee, thereafter; 2. After a student has completed less than one fourth of the course, the institution shall refund at least 70% of tuition, less the registration fee, thereafter; 3. After a student has completed one fourth, but less than one half of the course, the institution shall refund at least 45% of tuition, less the registration fee, thereafter; 4. After a student has completed one half or more of the course, the institution may retain 100% of the stated course price
CHARGES
Registration Fee ($ blank). Entrance Date ( blank)
Tuition ($ blank) Other Information ( blank)
Textbooks ($ blank)
Miscellaneous ($ blank)
to be paid as follows: ( blank)
I certify I have received and read a copy of the Enrollment Agreement and understand it is subject to representation only as expressed herein. I agree with these polices during my period of enrollment in blanks*
Student Name *

Student First Name Student Last Name
Student Electronic Signature *

Student First Name Student Last Name
Date *
ex: 01/01/2022
School Representative

School Representative First Name School Representative Last Name
Date
ex: 01/01/2022
INSTITUTION APPROVAL

School Representative First Name School Representative Last Name
Should be Empty:

H.E.A.R.T Academy Enrollment Agreement

The H.E.A.R.T Academy, LLC