Application and Enrollment Contract

Maryland Dental Assistant School 

Return Application to:                                                         

 Maryland Dental Assistant School

15638 Livingston Rd. unit 9

Accokeek MD 20607

Phone (301-212-1144

              (888-401-4555) ext 2

Fax (301-248-6509)

Email: mdas15638@gmail.com

Program: Basic Dental Assistant Training, 80 clock hrs, 10 weeks

Session____start__________ends__________

9:00am – 6:00pm each Saturday

Name: ___________________________________________

Address ____________________________

City _______________________ State ______

Zip code__________

Phone Number: (H)__________________(W)____________     

(C) ____________

Email Address __________________________________________________

Soc. Sec. #________________________________________

Birth date_____/_______/________

Past or present occupation ________________________________________________

Current employer _______________________________________________________

City _______________________ State _______ Zip _______

Emergency contact person __________________________ Relationship___________

City ________________________ State _______ Zip _______

(H) Phone _________________________

(W) phone ___________________________

Education information:

High School ____ GED ____ Date of Completion ___________

City ____________________ State _______ Zip ___________

College _____________________________

 Date of Completion _________________

City ______________________ State _______ Zip _________

Other _______________________________

Date of Completion _________________

Program Cost

Tuition-$2250.00

Registration fee $100.00(included in program cost)

Payment plan for the basic dental assistant training course:

* $2250.00 on or before the first day of class.

* $775.00 down payment then 150.00 at the beginning of each class (10 payments)

                        This option will cost $25.00 extra or approximately 1 % more

* $550.00 down payment, then $175.00 at the beginning of each class (10 payments)

                        This option will cost $50.00 extra or approximately 2 % more.

* $475.00 down payment then 185.00 at the beginning of each class (10 payments)

                        This option will cost $75.00 extra or approximately 3 % more

* $250.00 down payment, then $210.00 at the beginning of each class (10 payments)

                        This option will cost $100.00 extra or approximately 4 % more.

A $250.00 minimum down payment and $100.00 registration fee is required 7 days prior to the start of class.

“Any holder of this Consumer Credit Contract is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with proceeds hereof. Recovery hereunder by the debtor shall not exceed amounts paid by debtor hereunder”

 But remember we do fill up quickly and we take students on a first come first serve basis.

Please complete the following and remit payment  to reserve a place in our next class:

_________ Payment in full $1950.00            

_________ Down payment + $100.00 Registration fee = $___________

Check_______ Money Order ______________ MasterCard/Visa ________          

Credit card #____________________________Exp. Date____

Cardholder’s signature _______________________________

Print Cardholder’s name ________________________________________

Cancellation Policy

You may cancel the application agreement by written or oral notice, without any penalty or obligation and receive a full refund of any monies paid within 7 days (until midnight of the seventh day, excluding Saturdays, Sundays and legal Holidays) The application agreement is not binding until signed by the school director or designated school official.                                   

Refund Policy

1. Refunds will be based on the period of enrollment computed on the basis of program time expressed in clock hours.  Refund computations shall be based on scheduled hours of class attendance.  Leaves of absence and school holidays will not be counted as part of the scheduled class attendance. 
2. The termination date, for refund computation purposes is the last date of actual attendance by the student.
3. The effective date of termination, for refund consummation purposes, will be earliest of the following:
1. The last day of actual attendance, if the student is terminated by the school;
2. The date of receipt of written notice from the student;
3. Five school days following the last date of attendance;
4. The day following the last day of an approved leave of absence, if the student does not return from the leave of absence.
4. Refunds will be totally consummated with thirty (30) days after the effective date of termination. 
5. Grounds for termination are: unsatisfactory academic progress, excessive absenteeism, failure to comply with school rules, and/or non-conformance with the rules and regulations of the school. 
6. Refunds to students who fail to enter school will be made as follows:
1. An applicant who is not accepted by the school will receive a complete refund.
2. An enrollee, who cancels within the cancellation period described in the cancellation policy, whether or not the enrollee has attended classes, will receive a refund of all monies paid. 
3. An enrollee who cancels after the cancellation period described in the cancellation policy will receive a refund of all monies paid in excess of $100.00.
4. An enrollee will receive a full refund if educational service is discontinued by the school, preventing the student from completing. 
5. An enrollee will receive a full refund if the enrollment was procured as a result of any misrepresentation in advertising, promotional materials of the school, or representations by the owner or representations of the school.

7. Remember , you are responsible for the full tuition after you have attended 50% of the sessions  regardless of whether you  complete , pass or fail the course.

 8.After a student enters school, he/she may voluntarily cancel or terminate by contacting the school.  Charges to students who  terminate after entering school will be as follows. The $100.00 registration Fee will be retained by the school plus tuition and     fees, as indicated in the following schedule of refunded charges:

 Schedule of Refunded Charges

Proportion of total course or program                               

                                                           Fees                 Fees                

Taught by date of withdrawal                                      Retained        Refunded

Less than 10%                                      10%                 90%

10% up to but not including 20%         20%                80%                

20% up to but not including 30%         40%                60%                

30% up to but not including 40%          60%               40%                

40% up to but not including 50%          80%               20%

More than 50%                                       100%               0%