ENROLLMENT AGREEMENT RELATIONSHIP: TELEPHONE #: Dental Careers Foundation Dental Assisting Course (Ten Week, Saturday Only)

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1 DENTAL CAREERS FOUNDATION 755 S Mulford Rd. Rockford, IL Telephone: (815) Fax: (815) ENROLLMENT AGREEMENT STUDENT INFORMATION STUDENT NAME: ADDRESS: CITY/STATE/ZIP: PHONE NUMBERS: H) C) W) ADDRESS: SOCIAL SECURITY #: EMERGENCY CONTACT: RELATIONSHIP: TELEPHONE #: PROGRAM INFORMATION DATE OF ADMISSION: Winter ( ): The second-to-last Friday of January. Fall ( ): The second-to-last Friday of August. (Please see page 2 for exact dates) Dental Careers Foundation Dental Assisting Course (Ten Week, Saturday Only) DESCRIPTION OF COURSE: Dental Careers Foundation was established in Dr. Pacita Pumilia (a practicing dentist) has been a teacher at Marquette University and Rock Valley College, and has now been teaching for over 20 years at Dental Careers Foundation, a dental assisting school that she and her father, Dr. Albert Pumilia, established in Rockford, Illinois. Dr. Pacita Pumilia strives to train her students to be among the most skilled and prepared dental assistants on the market and she succeeds. Dental Careers Foundation is a fastpaced and well-structured program. Our Saturday s are broken into two sessions: Morning (9:00AM-12:00PM) which are lectures covering specific, mandatory reading assignments; and Afternoon (1:00PM-5:00PM) require class participation involving a hands-on lab with clinical instruction. Students are required to prepare for each week with reading assignments and weekly quizzes. (See our Course Catalog for a detailed break-down of each week s lectures either in the Catalog provided for you or online at: PREREQUISITE COURSES & OTHER REQUIREMENTS FOR ADMISSION TO PROGRAM / COURSE: In order to apply to Dental Careers Foundation, one must have a high school diploma (or GED equivalent) or be in the last semester of his/her last year in high school with a written letter from a school official advising the acceptance of the student. COURSE OBJECTIVES: To adequately train students to be dental assistants. Students will master topics such as: Dental Terminology; Radiology; Anesthetic, Isolation, Instrument Transfer, & Hand-piece Maintenance;

2 DENTAL CAREERS FOUNDATION ENROLLMENT AGREEMENT PAGE 2 Amalgam, Composite, and Sterilization; Mixing Cement and Alginate; Periodontics and Oral Surgery; Crown & Bridge, Temporaries; Endodontics, Orthodontics, and Job Interviews; Office Management; and Pediatric Dentistry (Further information of the information students will learn from this course can be found in our Course Catalog that was given to you with this Enrollment Agreement and can be viewed online at: PROGRAM INFORMATION (CONTINUED) PROGRAM START DATES : PROGRAM END DATES : Winter 2014: January 25 th Winter 2014: March 29 th Fall 2014: August 30 th Fall 2014: November 1 st Winter 2015: January 31 st Winter 2015: April 4 th Fall 2015: August 29 th Fall 2015: October 31 st Winter 2016: January 30 th Winter 2016: April 2 nd Fall 2016: August 27 th Fall 2016: October 29 th Winter 2017: January 28 th Winter 2017: April 1 st Fall 2017: August 26 th Fall 2017: October 28 th Winter 2018: January 27 th Winter 2018: March 31 st Fall 2018: August 25 th Fall 2018: October 27 th Winter 2019: January 26 th Winter 2019: March 30 th Fall 2019: August 31 st Fall 2019: November 2 nd CLASSES ON SATURDAYS ONLY TIME CLASS BEGINS: 9AM TIME CLASS ENDS: 5PM NUMBER OF WEEKS: 10 CLOCK HOURS: 80 DISCLOSURE INFORMATION A1.) Number of students admitted as of July 1st, 2013 of this reporting period: 18 A2.) Number of additional students who were admitted during the next 12 months: 0 A3.) The total number of students who were admitted during the 12 month reporting period: 18 A4.) The number of students who: a.) Transferred out of the program: 0 b.) Completed or graduated from a program: 18 c.) Withdrew: 0 d.) Are still enrolled: 0 A5.) The number of students enrolled who were: a.) Placed in their filed of study: 7 b.) Placed in a related field: 5 c.) Placed out of the field: 6 B1.) The number of students who took a state licensing exam or professional certification exam: 0 B2.) The number of students who took and passed a State licensing exam or professional certification exam: 0 C.) The number of graduates who obtained employment in the field who did not use the school s placement assistant during the 2013 reporting period: N/A D.) The average starting salary for school graduates employed during the 2013 reporting period: $10/hr

3 DENTAL CAREERS FOUNDATION ENROLLMENT AGREEMENT PAGE 3 FINANCIAL AID Dental Careers Foundation does not accept financial aid, but we do offer TWO convenient ways for you to pay our affordable program fees: $ at time of registration, or $ down payment at time of registration followed by payments of $110 at the beginning of each of the ten classes. TUITION & FEES Registration Fee......$150 Books: Dental Assisting Concepts (DAC)...$65 Clinical Study Guide (CSG)...$65 Instrument Identification Packet (IIP)...$20 Lab Supplies: X-Rays...$250 Cements...$100 Alginates...$150 Isolation Materials...$100 CPR-Health Provider Certification $30 Tuition $1,995 REFUND / CANCELLATION POLICY TOTAL COST FOR COURSE: $2,925 Dental Careers Foundation shall, when a student gives written notice of cancellation, provide a refund in the amount of the following: 1. When written notice of cancellation is given at least five business days prior to the first day of class (the first Saturday lecture of the semester, please see table on page 2 for exact date), all application-registration fees, tuition and any other charges shall be refunded to the student; 2. When written notice of cancellation is given after midnight of the fifth business day but prior to the first class (the first Saturday lecture of the semester, please see table on page 2 for exact date), the school may retain no more than the application-registration fee which may not exceed $150 or 50% of the cost of tuition, whichever is less; 3. When notice of cancellation is given after the student s completion of the first day of class attendance, but prior to the student s completion of 5% of the course of instruction, Dental Careers

4 DENTAL CAREERS FOUNDATION ENROLLMENT AGREEMENT PAGE 4 Foundation may retain the application-registration fee, an amount not to exceed 10% of the tuition and other instructional charges or $300, whichever is less; 4. When a student has completed in excess of 5% of the course of instruction, Dental Careers Foundation may retain the application-registration fee but shall refund a part of the tuition and other instructional charges in accordance with whichever of the following applies: Percentage of course completed (LEFT). Percentage of tuition DCF will retain (RIGHT): 10%.15% 20%.30% 30%.40% 40%.50% 50%.100% 5. When the student has completed 50% of the course of instruction, Dental Careers Foundation may retain the application-registration fee and the entire tuition and other charges. 6. Refunds shall be based on the last lesson completed. NOTICE TO STUDENT 1. Do not sign this agreement before you have read it or if it contains any blank spaces. 2. This agreement is a legally binding instrument and is only binding when the agreement is accepted, signed, and dated by the authorized official of the school or the admissions officer at the school s principal place of business. Read all pages of this contract before signing. 3. You are entitled to an exact copy of the agreement and any disclosure pages you sign. 4. This agreement and the school catalog constitute the entire agreement between the student and the school. 5. Any changes in this agreement must be made in writing and shall not be binding on either the student or the school unless such changes have been approved in writing by the authorized official of the school and by the student or the student s parent or guardian. All terms and conditions of the agreement are not subject to amendment or modification by oral agreement. 6. The school does not guarantee the transferability of credits to another school, college, or university. Credits or coursework are not likely to transfer; any decision on the comparability, appropriateness and applicability of credit and whether credit should be accepted is the decision of the receiving institution. STUDENT S RIGHT TO CANCEL The student has the right to cancel the initial enrollment agreement until (12:00AM) of the (5 th ) business day after the student has been admitted. If the right to cancel is not given to any prospective student at

5 DENTAL CAREERS FOUNDATION ENROLLMENT AGREEMENT PAGE 5 the time the agreement is signed, then the student has the right to cancel the agreement at any time and receive a refund on all monies paid to date within (7) days of cancellation. Cancellation should be submitted to the authorized official of the school in writing. STUDENT ACKNOWLEDGMENTS 1. I hereby acknowledge receipt of the school s catalog, which contains information describing programs offered, and equipment or supplies provided. The school catalog is included as part of this enrollment agreement and I acknowledge that I have received a copy of this catalog. 2. I have carefully read and received an exact copy of this enrollment agreement. 3. I understand that the school may terminate my enrollment if I fail to comply with attendance, academic, and financial requirements or if I fail to abide by established standards of conduct, as outlined in the school catalog. While enrolled in the school, I understand that I must maintain satisfactory academic progress as described in the school catalog and that my financial obligation to the school must be paid in full before a certificate or credential may be awarded. 4. I hereby acknowledge that the school has made available to me all required disclosure information listed under the Consumer Information section of this Enrollment Agreement. 5. I understand that the school does not guarantee transferability of credit and that in most cases, credits or coursework are not likely to transfer to another institution. In cases where transferability is guaranteed, Dental Careers Foundation must provide me copies of transfer agreements that name the exact institution(s) and include agreement details and limitations. 6. I understand that the school does not guarantee job placement to graduates upon program completion. 7. I understand that complaints, which cannot be resolved by direct negotiation with the school in accordance to its written grievance policy, may be filed with the Illinois Board of Higher Education, 431 East Adams Street, 2 nd Floor, Springfield, IL or at The student acknowledges receiving a copy of this completed agreement, the school catalog, and written confirmation of acceptance prior to signing this contract. The student by signing this contract acknowledges that he/she has read this contract, understands the terms and conditions, and agrees to the conditions outlined in this contract. It is further understood 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 the School Official. The student and the school will retain a copy of this agreement. Student s / Guardian s Signature (if under 18) Date Program Director s Signature Date

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