Enrollment Agreement

Enrollment Agreement

For entry into the Dental Assisting Program

Contemporary Health Career Institute, 101 John Robert Thomas Drive, Exton, PA 19341

*Read all sections of the document prior to signing*

The Dental Assisting program is 80 hours, consisting of ten courses, 8 hours each, for 10 weeks. The total cost of the program is $2,895.00 which includes a $150.00 registration fee, all text books, materials and supplies. This payment can be made using any of the following options;
- $2,895 at the time of registration which includes the $150 registration fee and the total cost of tuition in the amount of $2,745
- $150 at the time of registration, $2,745 at the first class
- $150 at the time of registration, followed by a payment plan found in the payment plan information sheet
- CHCI does not charge interest or late fees. A student who is delinquent on a payment plan is in violation of the behavior policy and is subject to termination from the program.
Payments may be made by check, cash, or major credit card. Following successful completion of all academic and tuition requirements, and receipt of a passing grade on each course, each student will be awarded a diploma for the program, a school pin, and a letter of recommendation from CHCI.

Refund Policy:
- An applicant rejected by the school is entitled to a refund of all monies paid. The date for refund calculation is the last date of recorded attendance or the date the student requests cancellation.
- The registration fee is fully refundable if the student notifies the school of their intent to cancel within 5 calendar days of the date of registration, or 10 days if notified in writing.
- A full refund will be made if the student cancels prior to the start of the program, following 10 days of the registration date. However, the $150 registration fee is not refunded.
- A 90% refund will be issued if the student completes up to and including eight hours of the program prior to withdrawal less registration fee.
- A 55% refund will be issued if the student completes more than eight but less than 20 hours of the program prior to withdrawal less registration fee.
- A 30% refund will be issued if the student completes more than 20 hours of the program, but less than 40 hours less registration fee.
- No refund will be issued for students completing more than 40 hours of the program.
A student who is dismissed from the school for disciplinary reasons will receive a refund in accordance with the above policy.

Additional policies may be found in the Student Information Publication.

CHCI is licensed by the Pennsylvania State Board of Private Licensed Schools

All grievances should be immediately expressed in writing to a director of CHCI. If a grievance is not satisfactorily resolved, a report should be made to the following governing body;

State Board of Private Licensed Schools

Pennsylvania Department of Education

607 South Drive, Floor 3E Harrisburg, PA 17120
Full Name
D.O.B.

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Do not use dashes or hyphen
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
The dates for the program I wish to enroll are as follows

(schedule can be found in Student Information Publication)
Dental Assisting Class I Plan to Attend
Start Date:
Refer to the dates listed for your chosen class.
Graduation Date:
Refer to the dates listed for your chosen class.
I certify that all information I provided is accurate. I also acknowledge that I have received, fully read, and understand this enrollment agreement as well as the student information publication.
By signing below, I acknowledge that no information was given to me contrary to that which is contained in the student publication, and that no guarantee or promise was made for employment or financial aid.
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature *If student is under 18
*only binding if signed by both school representative and student
Did someone refer you to the Dental Assisting Program? Yes, I was referred by
Should be Empty:

Enrollment Agreement

For entry into the Dental Assisting Program

Contemporary Health Career Institute, 101 John Robert Thomas Drive, Exton, PA 19341

State Board of Private Licensed Schools

Pennsylvania Department of Education

607 South Drive, Floor 3E Harrisburg, PA 17120

The dates for the program I wish to enroll are as follows

I certify that all information I provided is accurate. I also acknowledge that I have received, fully read, and understand this enrollment agreement as well as the student information publication.