MedDoc Training Enrollment Application

Full Name

Date of Birth

Date

Address

CityStateZip

Phone Number

Email Address

example@example.com

Required Documentation: Submit your picture ID below.

Take Photo

Do you have one of the following:

High school Diploma

GED

If neither you can email us a written statement explaining why you chose MedDoc Training. (meddoctraining1@gmail.com)

If you have one of the follwoing upload the picture below.

Take Photo

Please select the program and tuition rate you are enrolling under:

Standard Training Package (6 Weeks) - $700 Standard Training Package (6 Weeks, Discounted) - $350

Advanced Training Package (8 Weeks) - $1200 Advanced Training Package (8 Weeks, Discounted) - $600

Check only one option above

Name on Card Used for Payment

If the cardholder is not the student, check below and attach required documentation: I have permission to use this card, and I will submit a copy of the cardholder's valid ID.

Submit the cardholder's ID below.

Take Photo

Terms & Conditions (Initial Each Statement)

No Refund Policy - All course fees are non-refundable. Once payment is received and access to course material is granted, no refunds will be issued for any reason.Course Time Limit - Each course comes with a set number of weeks 6 or 8 Once your weeks are up, you will be removed from the class whether you have finished or not.Extensions/Re-Enrollment - To continue, you must purchase an extension before your time runs out OR re-enroll by paying again.Student Responsibility - It is your responsibility to complete all coursework, assignments, and seminars within the allotted time.

Student Responsibility - It is your responsibility to complete all coursework, assignments, and seminars within the allotted time.

Technology Requirements - Students must have access to a reliable internet connection, computer, or smart device.

Student Responsibility - It is your responsibility to complete all coursework, assignments, and seminars within the allotted time.

Code of Conduct - Students must act professionally and respectfully in all classes, group chats, and seminars.Dismissal Policy - Disrespect or rudeness toward the Director at any time may result in immediate removal from the course without refund.

requirements.

Certification - Certificates are awarded only upon successful completion of all course

Final Acknowledgment & Signature

I, the undersigned, certify that the information provided is true and correct to the best of my knowledge. I have read, understood, and agree to all Terms & Conditions above, and I understand the documentation requirements for enrollment.

Student Signature

Date