TMIKY - Choice MD - IDTKY Enrollment Agreement

CAMPUS INFORMATION:

Campus LocationBowling Green Campus 944 Fields Dr. Suite 103 Bowling Green, KY 42104Elizabethtown Campus 101 Magnet Drive, Suite 120 Elizabethtown, KY 42701Hopkinsville Campus 130 Hammond Drive Hopkinsville, KY 42240Lexington Campus 2720 Old Rosebud Rd. #230 Lexington, KY 40509London Campus 41 Old Pond Rd. London, KY 40741

Admission Representative:  

COURSE INFORMATION:

Program Name: Electronic Health Records - 14 weeks - $4,000Phlebotomy Technician - 14 weeks - $4,000Medical Administrative Assistant - 18 weeks - $4,000Medical Coding & Billing - 18 weeks - $4,000Medical Administrative with Medical Billing & Coding - 24 weeks - $7,800Medical Administrative with Electronic Health Records - 24 weeks - $7,800Medical Administrative with EHR and Medical Billing & Coding - 24 weeks - $9,800Clinical Medical Assistant - 16 weeks - $9,800Pharmacy Technician - 18 weeks - $9,800Dental Assistant - 16 weeks - $9,800 

STUDENT INFORMATION:

Full Name:

Street Address:

City: State: StateAlabamaAlaska ArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisiana MaineMarylandMassachusettsMichiganMinnesotaMississippiMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth Carolina North DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington West VirginiaWisconsin Wyoming Zip Code:  

Phone Number: E-Mail:

Social Security Number:  

Birth Date:

Emergency Contact Name:  

Emergency Contact Phone Number:  

Program Type: Certificate  Delivery Method: BlendedDistance Learning 

Total Clock Hours: 100120140180200208220240250300360              

Total Weeks:  10121416182224252630

ADDITIONAL PROGRAM FEES NOT INCLUDED IN TUITION

Access Code & E-Book                                            $ 0300 
CPR, TB, Hep B & Uniform                                      $ cost varies (estimated)
Stethoscope                                                             $ cost varies (see catalog)
National Exam                                                          $ cost varies (paid directly to them)
Online Technology Requirements                            $ cost varies (see catalog)
Dental Teeth Fee (If Applicable)                               $ 60.45  (paid to school)

ACCESS CODE ACKNOWLEDGMENT 

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Document name: Enrollment Agreement

Unique Document ID: 5c40b5fb2d63f63dd99f2cab08d22c584a754757

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Timestamp	Audit
August 19, 2022 2:17 pm EDT	Enrollment Agreement Uploaded by Greg Goins - [email protected] IP 2600:1700:7b18:ec90:1da2:3263:11ff:dd26
August 19, 2022 2:18 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
October 3, 2022 12:23 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
October 18, 2022 8:09 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
November 2, 2022 1:52 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
November 2, 2022 1:52 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
November 2, 2022 1:53 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
November 10, 2022 2:55 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
December 14, 2022 5:05 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
January 9, 2023 6:38 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
January 9, 2023 11:20 pm EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
January 10, 2023 1:59 am EDT	TMIKY Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
March 1, 2023 8:58 am EDT	TMIKY Documents - [email protected] added by - as a CC'd Recipient Ip: 99.190.9.234
July 10, 2023 2:00 pm EDT	TMIKY Documents - [email protected] added by - as a CC'd Recipient Ip: 2600:1700:7b18:ec90:1da2:3263:11ff:dd26

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