Enrollment Application (Rev 2025)

Enrollment Application

Rev. E-2025
To apply for training courses at MBA USA, Inc, complete this enrollment application.

A copy of this application will be emailed to you upon submittal.

We will review your application and, upon approval, email you a seperate Confirmation of Registration. You are not registered for your training course until we send you written confirmation.

Information requested on this application is for the purpose of identifying applicants in order to confirm their enrollment eligibility. This information is kept for the purpose of maintaining our school records and is not provided to other parties unless required by law.

Providing this information is voluntary, however not providing any requested information may affect the acceptance of your application.

MBA USA, Inc. is licensed by the Kentucky Commission on Proprietary Education
License no. R-KY-0222

Applicant Information

Please enter all requested information.
Name:*

First NameMiddle NameLast NameSuffix
Home Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
If you have an APO or FPO address:
Select United States for Country and enter your physical location in this box.
Phone Number:*
Please enter a valid phone number.
This phone number is:*

Personal cell or home phoneWork
Email:*
A copy of this form will be sent to the email address provided.
Date of Birth:*

MonthDayYear
Date
Place of Birth:*
Are you a U.S. Citizen*

YesNo
Have you ever been convicted of a felony?*

YesNo
Current Employer
Company Name*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years Employed Here*

Less than 5 yearsMore than 5 years
Previous Employer

If less than 5 years at current employer
Previous Employer Name*
Previous Employer's Name
Previous Employer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Employed Here*
Character Reference
Name of Character Reference (no family members)*

First NameLast Name
Address (City and State)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference Phone Number*
Please enter a valid phone number.
Course Information

If applying for multiple consecutive courses, you may select them all on one application.
Government Security (GSA) Course you are applying for:

GSA Certified Safe & Vault Technician With GSA Approved InspectorGSA Approved Container Inspection CourseGSA Container IdentificationSargent & Greenleaf Models 2937 & 2740B Lock TrainingKaba-Mas X-10 Factory CertificationKaba-Mas CDX-10 Factory CertificationDrilling GSA Approved Containers and Locks
GSA Certified Safe & Vault Technician With GSA Approved Inspector*
Because this course fills up quickly, we may allow you to choose to be put on a waiting list for certain dates. You may choose "Waiting list" here, or you may choose the next available class dates and ask to be on a waiting list for your preferred dates in the comment box near the end of this application.

Please be aware that being on a waiting list only does not give any preferential status for later class dates.

Being on a waiting list does not require any payment or deposit and is not an obligation on either of our parts.
Waiting List for GSA SVT*
GSA Approved Container Inspection Course*
GSA Container Identification*
Sargent & Greenleaf Models 2937 & 2740B Lock Training*
Kaba-Mas X-10 Factory Certification*
Kaba-Mas CDX-10 Factory Certification*
Drilling GSA Approved Containers and Locks*
Physical Security Course you are applying for:

Government Physical Security TrainingCommercial Physical Security TrainingProfessional LocksmithingAdvanced Locksmithing - Locksmith Specialties
Government Physical Security Training*
Commercial Physical Security Training*
Professional Locksmithing*
Advanced Locksmithing - Locksmith Specialties*
Commercial, Safe & Banking Class(es) you are applying for:

Mechanical Safe LocksSafe Lock ManipulationElectronic Safe LocksProfessional Safe DrillingSafe Deposit LocksTime Locks
Mechanical Safe Locks*
Safe Lock Manipulation*
Electronic Safe Locks*
Professional Safe Drilling*
Safe Deposit Locks*
Time Locks*
Method of Payment

Your enrollment application will not be processed without one of the following:

• Recognized funding form for training (SF182, or similar).
• Non-refundable deposit. The balance must be paid by the first day of class.
• Payment in full.

The amount of a deposit depends on the class and how many classes are being applied for.

• $500 non-refundable depsoit for GSA Certified Safe and Vault Technician
• $100 per class non-refundable deposit for all other classes.
Payment for this training will be by:*

GOVERNMENT FUNDING: I will email a completed and approved Standard Form 182 or other recognized government funding form.ONLINE: I would like an invoice by email to pay in full online.ONLINE: I would like an invoice by email to pay the non-refundable deposit online and pay the remaining balance by the first day of class.BY PHONE: Someone will call with payment information (credit card, etc.) +1-859-887-0496OTHER: I would like to mail a check or make other arrangements.
Please send your completed and approved SF182 or other funding approval form to education@mbausa.com

Your enrollment will not be confirmed until this is received. After submitting your form, any payments are not necessary until the first day of class.

If you are with a state government or other orginization that uses some other sort of training authorization form or purchase order, contact us to make arrangements for submittal.
An email invoice with a link to pay online will be sent to the email address you provided. If another individual will be paying, the email may be forwarded to them. Email invoices must be paid within 7 days.
Cancellation and Refund Policies

Should it be necessary for you to cancel your registration, the following policy shall apply:

If you paid a deposit with your application:
- No additional fees will be due. Deposits are non-refundable, but may be applied to a future class if cancelling at least 30 days before your registered training.
If you made payment in full:
- We will refund, at your request, the payment less an amount equal to a deposit that would otherwise have been collected. ($500 for the GSA Certified Safe and Vault Technician course, or $100 for each of all other classes).
- If canceling at least 30 days before the beginning of class, the withheld amount may be applied to a future class within one year.
- If cancelling less than 30 days before the beginning of class, the withheld amount is forfiet.
- Extenuating circumstances will be considered on a case by case basis.
Once class has begun, should it be necessary to cancel or dismiss a student, refunds will be based on the percentage of the course completed on the day of cancellation. When half of a training course is completed, no refunds will be made.

If not present the first day of class, and without written notice of cancellation to MBA USA, Inc., you forfeit all fees and deposits paid and will be billed for any unpaid balance.

MBA USA, Inc. reserves the right to cancel training classes as we determine necessary. Full refunds will be issued to students who have paid for cancelled training.

Any refunds will be made by MBA USA, Inc. within 30 days.

Commonwealth of Kentucky Consumers Right of Cancellation
- You may cancel this contract, without penalty or obligation, within 10 business days from the date you sign the contract.
- You may also cancel this contract if, upon doctor’s order, you cannot physically receive the services, or you may cancel the contract if the services cease to be offered as stated in the contract. If you cancel this contract for either of these reasons, the seller, MBA USA, Inc. may keep only a portion of the tuition or contract price.
- You may notify the seller, MBA USA, Inc., of your intent to cancel by giving written notice to: MBA USA, Inc., 200 Orchard Drive, Nicholasville, KY 40356-2357 or by electronic mail to education@mbausa.com.
- MBA USA, Inc. reserves the right to cancel a class due to insufficient enrollment. You will be notified and a full refund will be issued.
Filing a complaint with the Kentucky Commission on Proprietary Education To file a complaint with the Kentucky Commission on Proprietary Education, each person filing must submit a completed “Form to File a Complaint” (PE-24) to the Kentucky Commission on Proprietary Education by mail to Kentucky Commission on Proprietary Education, 500 Metro Street, 4th Floor, Frankfort, Kentucky 40601. This form can be found on the website at www.kcpe.ky.gov.

Student Protection Fund
KRS 165A.450 requires each school licensed by the Kentucky Commission on Proprietary Education to contribute to a Student Protection Fund which will be used to payoff debt incurred due to the closing of a school, discontinuance of a program, loss of license, or loss of accreditation by a school or program. To file a claim against the Student Protection Fund, each person filing must submit a completed “Form for Claims Against the Student Protection Fund”. This form can be found on the website, www.kcpe.ky.gov.
Application Submission

Information requested on this application is for the purpose of identifying applicants in order to confirm their enrollment eligibility. This information is kept for the purpose of maintaining our school records and is not provided to other parties unless required by law. Providing this information is voluntary, however not providing any requested information may affect the acceptance of your application.

Upon acceptance of this application, we will email you a seperate enrollment confirmation.
Please confirm:*

I agree that I will not use any skills learned in classes at MBA USA, Inc. for illegal or improper activities.
Signature*
Type your full name. This constitutes your electronic signature.
Please confirm:*

I understand that typing my name in the signature box constitutes my legal signature.
Comments
Waiting list for earlier class, special needs, questions, etc.
Date

MonthDayYear

AM/PM Option
Should be Empty:

Enrollment Application

Applicant Information

Course Information