Enrollment Agreement


TMIKY - Choice MD - IDTKY Enrollment Agreement

CAMPUS INFORMATION:

Admission Representative:  

 

COURSE INFORMATION:

Program Name:  

 

STUDENT INFORMATION:

Full Name:

Street Address:

City: State: Zip Code:  

Phone Number: E-Mail:

Social Security Number:  

Emergency Contact Name:  

Emergency Contact Phone Number:  

Program Type: Certificate  Delivery Method:  

Total Clock Hours:               Total Weeks:  

ADDITIONAL PROGRAM FEES NOT INCLUDED IN TUITION
Access Code & E-Book                                            $  
Name Tag                                                                 $ 10   (paid to school)
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)                               $ 80  (paid to school)
X-ray certification for Basic Dental  (If Applicable)   $ 150 (paid to school)

 

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Signature Certificate
Document name: Enrollment Agreement
lock iconUnique Document ID: 7861a00419ee906c23d63aa575d0af0107001eb7
Timestamp Audit
July 21, 2020 3:50 pm EDTEnrollment Agreement Uploaded by Cassie Black - [email protected] IP 99.190.9.234
July 21, 2020 6:55 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
July 22, 2020 7:36 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
July 22, 2020 7:37 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
July 29, 2020 6:58 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
July 29, 2020 7:31 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
August 10, 2020 8:47 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
December 29, 2020 2:18 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
December 6, 2021 10:12 am EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 172.70.38.252
January 20, 2022 2:23 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
March 31, 2022 3:00 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
May 17, 2022 11:20 am EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
May 17, 2022 11:21 am EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
May 17, 2022 11:22 am EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
May 17, 2022 1:11 pm EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
May 24, 2022 9:15 am EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
May 31, 2022 10:52 am EDTTMIKY Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234