Online.TMIKY Enrollment Agreement

Enrollment Agreement

Choice Career Tech (CCT) & The Medical Institute of Kentucky (TMIKY)
CAMPUS INFORMATION:
Campus:*
COURSE INFORMATION:
Program Name: *
Admission Representative:*
STUDENT INFORMATION:
Student Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Social Security Number:
Birthdate: *

MonthDayYear
Date
Emergency Contact Name: *

First NameLast Name
Emergency Contact Phone Number:*
Please enter a valid phone number.
Method of Payment:*
Program Cost:
Orientation Date: *

MonthDayYear
Date
Start Date:*

MonthDayYear
Date
End Date:*

MonthDayYear
Date
Program Type:*
Delivery Method:*
Total Clock Hours:*
Total Weeks:*
ADDITIONAL PROGRAM FEES NOT INCLUDED IN TUITION
National Exam *
Paid Directly to Them
Online Technology Requirements *
See Catalog
Optional Observation/Externship Requirements *
See Catalog
Access Code *
Paid to School
Please Read Below*

I understand that there are additional program fees not included in the tuition and that will be the responsibility of the student.
ACCESS CODE ACKNOWLEDGMENT
Please Select ONE of the Following:*

I have agreed to have my Access Code fee of $300 included in the Financing of my Tuition.I have agreed to pay for the Access Code at the time of Enrollment.
By initialing below you are acknowledging you have chosen the access code payment option that best suits your financial need.

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By initialing below you acknowledge and understand by including your access code additional program fee, within your financing of tuition, this will no longer be refundable.

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Please read this Enrollment Agreement thoroughly as you are agreeing to the following:
Existence of the Kentucky Student Protection Fund.

Pursuant to KRS 165A.450 All licensed schools, resident and nonresident, shall be required to contribute to a student protection fund. The fund shall be used reimburse eligible Kentucky students, to pay off debts, including refunds to students enrolled or on leave of absence by not being enrolled for one (1) academic year or less from the school at the time of the closing, incurred due to the closing of a school, discontinuance of a program, loss of license, or loss of accreditation by a school or program.

Process for Filing a Claim Against the Student Protection Fund.

To file a claim against the Kentucky Student Protection Fund, each person filing must submit a signed and completed Form for Claims Against the Student Protection Fund, Form PE-38, 2017 and provide the requested information to the following address: Kentucky Commission on Proprietary Education, 500 Mero Street, 4th Floor, Frankfort, KY 40601. The form can be found on the website at http://www.kcpe.ky.gov/.

Filing a Complaint with the Kentucky Commission on Proprietary Education

To file a complaint with the Kentucky Commission on Proprietary Education, a complaint shall be in writing and shall be filed on Form PE-24, 2017 Form to File a Complaint, accompanied, if applicable, by Form PE-25, Authorization for Release of Student Records. The form may be mailed to the following address: Kentucky Commission on Proprietary Education, 500 Mero Street, 4th floor, Frankfort, Kentucky 40601. The forms can be found on the website at http://www.kcpe.ky.gov/.
SCHOLARSHIP:
Scholarship Type: *
Scholarship Amount:*
By initialing below, you are accepting the institutional scholarship(s) awarded and understand any and all provided by CCT or TMIKY are based on individual qualifications at the time of application and are between the recipient and said institution.
Initial:*

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By initialing below, you are acknowledging you have read and understand this agreement and acknowledge I will receive an exact copy, today, of this enrollment agreement upon execution. You understand the awarded institutional scholarship cannot be transferred to another institution, or person, and may only apply to certain offered programs. You are also required to maintain full time enrollment and minimal academic standards per the student catalog. You understand that if you default upon this agreement, the awarded institutional scholarship will be revoked, and you will be responsible for any and all fees set by any and all financial lenders.
Initial:*

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MEDIA POLICY:

I, Undersigned, do hereby give my consent and agree the CCT & TMIKY employees have the right to take photographs, videotape, or digital recordings of me to use in any and all media outlets. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I understand there will be no financial or other forms of remuneration for any of the above, either for initial or subsequent transmission or playback. I represent I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.
Initial:*

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CODE OF CONDUCT:

CCT & TMIKY students are expected to abide by all the standards and policies established by CCT & TMIKY. Students behaving unethically or failing to abide by the school’s Code of Conduct will be subject to disciplinary action up to and including dismissal from CCT or TMIKY as stated within the school catalog. A dismissed student’s tuition refund is calculated in accordance with the school’s refund policy.

Students are expected to: Comply to the school enrollment agreement; Follow and obey all codes of conduct along with applicable CCT or TMIKY policies and procedures, local, states, and federal laws; Not share login credentials, documents, curriculum, links or any other school program materials with other students or non-students; Maintain and uphold academic and professional integrity and honesty; Do not copy or reproduce course/program materials; Maintain professional written and verbal communication with CCT or TMIKY team members, instructors, support staff, and other students. Zero tolerance for any form of abuse is permitted; Instigate, participate in, soliciting, aiding others to commit a violation of the code of conduct or actions unfavorably reflected upon the school or its students; Disruptive behavior within the learning environment or school sponsored activities, to include off-campus; Physical threats of any nature; Falsify or provide misleading information; Refusal to communicate with CCT or TMIKY staff; Thirty days of Academic Probation without a formal Leave of Absence or without effort to retain good standing within his/her program; Failure to maintain tuition payment agreement.
Initial:*

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TAX INFORMATION

CCT & TMIKY post-secondary educational establishments are NOT eligible for Title IV funding or Student Aid programs administered by the U.S. Department of Education. The federal government generally does not provide loans, grants or other forms of financial assistance to students attending a non-accredited college. (www.irs.gov)

According to the IRS, students can only deduct their loan interest if the loan was used at a school that participates in the U.S. student aid program. This is limited to schools with approved accreditation. Therefore, CCT & TMIKY schools are not eligible to provide tax Form 1098-T for tuition statement or Form 1098-E for student loan interest statement. Personal loans are utilized for educational purposes, and students are advised and must authorize this attestation in advance of attendance.

Tax preparers will be supplied a W-9 Form upon request. CCT & TMIKY employees are not qualified to advise students on tax matters.
Initial:*

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CANCELLATION & REFUND POLICY:
Student must provide written notice of cancellation/withdrawal by electronic submission to include: name, date, program enrolled, and reason for cancellation to: http://choicecareertech.com/withdraw-request/

Program Cancellation

The school may cancel a program at its discretion. Should this occur, any students enrolled prior to cancellation, will be notified of this change and will have the option of applying all monies paid toward another program or receiving a refund of all tuition paid within 30 days of the cancellation date.

Cancellation

An applicant, who provides electronic submission of cancellation after executing the enrollment agreement, but prior to the digital orientation of the program, is entitled to a full refund of all paid tuition. Students have three months from enrollment date to seek any refunds of paid tuition. All refunds will be made within 30 days of the written notice receipt.

Withdrawal Procedure
1. Students choosing to withdraw from a program after the digital orientation date are required to submit an electronic request notice of withdrawal as required above (attendance will be calculated until electronic submission is received).
2. Choice Career Tech has selected three consecutive weeks with no activity of academic requirements, without prior administrative approval, as the unofficial date which a student is deemed to have withdrawn. Students have three months from the last attended date to request a refund of monies paid towards tuition. After this deadline, no refunds will be issued.
3. For students seeking a refund of tuition: Refunds are based on the amount of tuition paid, fees not included in tuition are non-refundable. Administrative fee of $400 will be deducted from the refund amount. All refunds will be made within 30 days of receipt of electronic submission. Refunds will be calculated as follows: Digital Orientation through Week 2- 75% refund, Week 3 through Week 4- 50% refund, Week 5 through Week 6- 25%, No refunds after Week 6. Students not eligible for refund will be offered the option to take a Leave of Absence (LOA) and return to complete the program within three months from withdrawal date.
4. Students who have acquired or been offered employment in the field upon enrollment are not eligible for tuition refund. Students who receive a refund will not be eligible to receive any certificates as all courses in the program must be completed to receive a certificate of completion. Students who receive a refund are not eligible for any future institutional scholarships.
Student must provide written notice of cancellation/withdrawal by electronic submission to include: name, date, program enrolled, and reason for cancellation to: http://online.tmiky.com/withdraw-request/

Program Cancellation

The school may cancel a program at its discretion. Should this occur, any students enrolled prior to cancellation, will be notified of this change and will have the option of applying all monies paid toward another program or receiving a refund of all tuition paid within 30 days of the cancellation date.

Cancellation

An applicant, who provides electronic submission of cancellation after executing the enrollment agreement, but prior to the digital orientation of the program, is entitled to a full refund of all paid tuition. Students have three months from enrollment date to seek any refunds of paid tuition. All refunds will be made within 30 days of the written notice receipt.

Withdrawal Procedure
1. Students choosing to withdraw from a program after the digital orientation date are required to submit an electronic request notice of withdrawal as required above (attendance will be calculated until electronic submission is received).
2. TMIKY has selected three consecutive weeks with no activity of academic requirements, without prior administrative approval, as the unofficial date which a student is deemed to have withdrawn. Students have three months from the last attended date to request a refund of monies paid towards tuition. After this deadline, no refunds will be issued.
3. For students seeking a refund of tuition: Refunds are based on the amount of tuition paid, fees not included in tuition are non-refundable. Administrative fee of $200 will be deducted from the refund amount. All refunds will be made within 30 days of receipt of electronic submission. Refunds will be calculated as follows: Digital Orientation through Week 2- 75% refund, Week 3 through Week 4- 50% refund, Week 5 through Week 6- 25%, No refunds after Week 6. Students not eligible for refund will be offered the option to take a Leave of Absence (LOA) and return to complete the program within three months from withdrawal date.
4. Students who have acquired or been offered employment in the field upon enrollment are not eligible for tuition refund. Students who receive a refund will not be eligible to receive any certificates as all courses in the program must be completed to receive a certificate of completion. Students who receive a refund are not eligible for any future institutional scholarships.
Initial:*

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INFORMATION AUTHORIZATION:

Complete this portion only if you want us to provide information about you to an individual or group. Type the name of those who you authorize permission of information (academics and/or financial) to be released.
Name

First NameLast Name
Relationship
Name

First NameLast Name
Relationship
CATALOG DELIVERY:
Upon execution of this agreement CCT or TMIKY Catalog, which reflects current policies, regulations, and services, will be electronically delivered to you on the date of this agreement. The date executed is Date*
STUDENT ACKNOWLEDGEMENTS
Check All Below:*

By checking this you are agreeing to Attestation of a high school graduation or equivalent. You agree to supply the necessary documents if assigned by CCT or TMIKY.I understand that CCT or TMIKY may terminate my enrollment if I fail to abide by the established code of conduct, as initiated above and outlined in the school catalog. I acknowledge my financial obligation to the school must be paid in full before a certificate of completion is awarded.I understand that CCT or TMIKY does not guarantee job placement to graduates/students upon program completion or upon graduation.I have carefully read and understand this is a legal binding document and there have been no verbal or written agreements or promises other than those appearing in this agreement.I have read and understand this agreement and acknowledge I will receive an exact copy, today, of this enrollment agreement upon execution. This is a legal binding document and there has been no verbal or written agreements or promises other than those appearing in this agreement.I understand that if I default upon this agreement, I will be responsible for payment of any collection fees and/or attorney fees incurred by CCT or TMIKY.
Are you over 18 years of age or older?

YesNo
Legal Guardian Signature*

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Date of Legal Guardian Signature*

MonthDayYear
Date
Your Signature

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Should be Empty:

Enrollment Agreement

CAMPUS INFORMATION:

COURSE INFORMATION:

STUDENT INFORMATION:

ADDITIONAL PROGRAM FEES NOT INCLUDED IN TUITION

ACCESS CODE ACKNOWLEDGMENT

Please read this Enrollment Agreement thoroughly as you are agreeing to the following:

SCHOLARSHIP:

CANCELLATION & REFUND POLICY:

CATALOG DELIVERY:

STUDENT ACKNOWLEDGEMENTS