Bridgeport University Fellowship 100 hour Program
By completing this agreement, I commit to enrollment in the Bridgeport University Fellowship program. Tuition: $3000 total – Payment Structure: $500 due at each of the six modules. A credit card will be kept on file. Tuition will be charged regardless of attendance. Tuition is nonrefundable once the program begins.
Name
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First Name
Last Name
License Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (For calls and Texts)
*
Email
*
example@example.com
Choose Your Payment Option Below:
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Pay In Full - $3000
Pay 6 Monthly Payments - $500/month (Jan-June)
I understand that I am committing to the full 100 program for a total $3000 payment. Signature
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