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Career Academy Of Marquette ENROLLMENT FORM
| Applicant Name | |
| Street Address/PO Box | |
| City, State, Zip | |
| Phone: | |
| Date of Birth | |
| Soc. Sec. # (optional) | |
| Email: (optional) |
PLEASE SELECT YOUR CERTIFICATE PROGRAM CHOICE(S):
| Medical Terminology (MEDTRM100) (60 Hours) - $975 includes all books materials | |
| Human Anatomy (MEDANA200) (60 Hours) - $975 includes all books materials | |
| Medical Secretary/Receptionist (MEDSEC300) (72 Hours) - $1295 Includes all books and materials | |
| Medical Billing/Coding (MEDBILLCOD400) (60 Hours) - $1295 Include all books and materials | |
| CCA Examination Preparation (MEDBILLCOD500) (60 Hours) - $995 include all books and materials | |
| CCS-P Examination Preparation (MEDBILLCOD501) (60 Hours) - $1090 include all books and materials | |
| CCS Examination Preparation (MEDBILLCOD502) (60 Hours) - $1080 include all books and materials | |
| Medical Transcription (MEDTRN500) (60 Hours) - $975 Includes all books and materials | |
| RMT Examination Preparation (MEDTRAN500) (60 Hours) - $950 includes all books and materials | |
| 6-Hour Software Classroom Program - $150 Includes all books and materials - Indicate software (Word, Excel, Access, etc.): | |
| 2-Hour Software Classroom Program - $300 Includes all books and materials- Indicate software (Word, Excel, Access, etc.): |
| Number of Check or Money Order Enclosed | |
| Amount of Check or Money Order Enclosed | |
| Credit Card Type (circle one) | VISA MC Discover |
| Name on Credit Card | |
| Expiration date on Credit Card | |
| Please mail enrollment form and payment to: CAREER
ACADEMY OF MARQUETTE |
Or fax credit card enrollments to 906.226.2743 |
| APPLICANT
SIGNATURE: My signature here acknowledges that I have read and understood the tuition agreement below. |
DATE: |
For questions, e-mail todd@careeracademyofmarquette.com or call (906) 226-2743
TUITION AGREEMENT:
The certificate program book packages are assembled at the time of enrollment to provide the student with the most current materials. All enrollments are confirmed by email or phone call. All tuition and fees paid by the applicant shall be refunded if the school does not accept the student application. The school may retain an application fee of not more than $25.00 if the application is denied. All tuition and fees paid by the applicant shall be refunded if requested within three business days after signing a contract with the school. All refunds shall be returned in 30 days. Certificate and transcript are awarded upon successful completion of each course and/or program.
PAYMENT PLAN
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