Undergraduate Research Assistant Program
Enrollment & Installment Form
Name
*
First Name
Last Name
Phone/WhatsApp
*
-
Country Code (+)
Phone Number
Email
*
example@example.com
School Name & Address
*
Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Billing Address
*
Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Specialty of Interest (First and Second Preferences)
*
Program Selection
*
Undergraduate Research Assistant Program
Payment Mode
*
US Bank to Bank Zelle (Ask Organization's Bank details)
Debit / Credit Card (Notify and pre-approve this national/international transaction from your credit card company in order to avoid "Decline of Transaction")
Image of "US Bank to Bank Zelle" (Ask us for the bank receipt to upload here)
Debit/Credit Card Users
*
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( X )
Installment 1 -
$
2,000.00
Due Date: At the time of enrollment
Installment 2 -
$
2,000.00
Due Date: Within 30 days of the enrollment date
Installment 3 -
$
2,000.00
Due Date: Within 60 days of the enrollment date
Late fees -
$
100.00
Enter coupon
Apply
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Debit/Credit Card
I have discussed the program details with Research Update Team. I agree to pay the FULL fees. (Non-refundable)
*
Yes
I will sign up for the Post-Enrollment Strategy Planning Session using the link below...
*
https://form.jotform.com/212072076724148
Signature
*
Submit
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