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Student Enrollment Agreement
MM slash DD slash YYYY
Student I.D. #
District of Columbia
Northern Mariana Islands
U.S. Virgin Islands
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Program title: Dental Assisting Program length: 13-weeks with a total of 118 clock hours Total cost of 13-week Dental Assisting Program: $5,700
• Every student participating in the 13-week dental assisting program will be provided with all textbooks, study aids, notes, one (1) pair of scrub bottoms, one (1) UDA t-shirt, and one (1) pair of safety glasses. All dental equipment and technology are included. UDA will cover costs for each students’ first attempt at passing the Radiation Health and Safety Exam (RHS) and Infection Control Exam (ICE). Any failed attempts requiring a student to retake these exams must be covered by the student. Tuition and application fee will be refunded based on guidelines listed in Section 7 and Section 8 below. Fees associated with RHS and ICE will be refundable up until the point the student registers and exams are paid for by UDA. Once the student has been registered and payment has been processed, the exam fees are no longer refundable.
• Application fee: $75.00
• Textbooks, supplies and equipment: $190.00
• Radiation Health & Safety Exam (RHS), Infection Control Exam (ICE): $325.00
• Tuition for the 13-week program (includes mandatory $35.00 cardiopulmonary resuscitation (CPR) certification): $5,110.00
INSTITUTIONAL PAYMENT OPTIONS
Students are required to submit a $515.00 down payment upon acceptance into the UDA program, which covers the cost of textbooks, supplies, equipment, RHS exam, ICE, and CPR certification. To pay the remaining balance, the institutional payment options are detailed below. These options are available to all students of UDA. We are here to help make your educational goals a reality. Please discuss any further questions or concerns with our Program Director or Financial Representative. All payment options exclude the $75.00 application fee and $515.00 down payment.
One full payment a week prior to start of classes
Two equal payments, one week prior to start of classes, and one week prior to start of week six classes
Three equal payments, one week prior to start of classes, one week prior to start of week four classes and one week prior to start of week eight classes
Service Fee Per Payment
Payment with Service Fee
Students Initials Page 1
CANCELLATION AND REFUND POLICY
An applicant denied by UDA is entitled to a refund of all monies paid.
An applicant who provides written notice of cancellation within three days (excluding Saturday, Sunday, a federal, or state holiday) of signing an enrollment agreement is entitled to a refund of all monies paid. UDA shall provide the refund no later than 30 days of receiving the notice of cancellation.
An applicant requesting cancellation more than three days after signing an enrollment agreement and making an initial payment, but prior to entering school, is entitled to a refund of all monies paid, minus the application fee of $75.00.
REFUND AFTER COMMENCEMENT OF CLASSES
1. Procedure for Withdrawal / Withdrawal Date
a. A student choosing to withdraw from UDA after the commencement of classes is to provide written notice to the UDA Program Director. The notice is to indicate the expected last date of attendance and be signed and dated by the student.
b. For a student who is on authorized Leave of Absence (LOA), the withdrawal date is the date the student was scheduled to return from the leave and failed to do so.
c. A student will be determined to be withdrawn from the institution if the student has missed 12 hours or more of class/clinic time without prior arrangements.
d. All refunds will be issued within 30 days of the determination of the withdrawal date.
2. Tuition Charges/Refunds
a. After the commencement of classes, the tuition refund less the application fee of $75.00 amount shall be determined as follows:
Clock Hours Attended
Less than 10%
Less than 20%
Less than 30%
Less than 40%
Less than 50%
More than 50%
b. The percentage of clock hours attended is determined by dividing the total number of clock hours elapsed from the student’s start date to the student’s last day of attendance, by the total number of clock hours in the program.
3. Books, Supplies and Fees
All books, supplies, and fees paid by the down payment are non-refundable once class commences and student takes possession. UDA will purchase these for each individual student for the program.
Refunds will be issued within 30 days of the date of student notification, or date of school determination (withdrawn due to absences or other criteria as specified in the UDA Catalog), or in the case of a student not returning from an authorized LOA.
5. Holder in Due Course Statement
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 the proceeds, hereof Recovery hereunder by the debtor shall not exceed amounts paid by the debtor (FTC Rule effective 5-14-76).
Students Initials Page 2
THE STUDENT UNDERSTANDS
1. UDA does not accept credit for previous education, training, work experience.
2. UDA does not guarantee job placement to graduates upon program completion or upon graduation.
3. UDA reserves the right to reschedule the program start date when the number of students scheduled is too small.
4. UDA will not be responsible for any statement of policy or procedure that does not appear in UDA catalog.
5. UDA reserves the right to discontinue any students’ training for unsatisfactory progress, nonpayment of tuition, or failure to abide by school rules.
6. UDA does not guarantee the transferability of credits to a college, university, or institution. Any decision on the comparability, appropriateness, and applicability of credits and whether they should be accepted is the decision of the receiving institution.
7. This document does not constitute a binding agreement until accepted in writing by all parties.
1. I hereby acknowledge receipt of UDA’s Catalog, which contains information describing the program offered and equipment/supplies provided. UDA’s Policies and Procedures and the UDA Catalog are included as a part of this enrollment agreement, and I acknowledge that I have received a copy of these documents.
Students Initials 1
2. I have carefully read and received an exact copy of this enrollment agreement.
Students Initials 2
3. I understand that UDA may terminate my enrollment if I fail to comply with attendance, academic, and financial requirements, or if I disrupt the normal activities of UDA. While enrolled in UDA, I understand that I must maintain satisfactory academic progress as described in UDA’s Catalog. My financial obligation to UDA must be paid in full before a certificate of completion will be awarded.
Students Initials 3
4. I also understand that UDA does not guarantee job placement to graduates upon program/course completion or upon graduation.
Students Initials 4
I, the undersigned, have read and understand this agreement and acknowledge receipt of a copy. It is further understood and agreed that this agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and UDA Official. I also understand that if I default upon this agreement I will be responsible for payment of any collection fees or attorney fees incurred by Unity Dental Assisting. My signature below signifies that I have read and understand all aspects of this agreement and do recognize my legal responsibilities regarding this contract.
Name of Student or Parent/Guardian
Signature of Student
Students Initials Page 3
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