By completing Page 1 (Information) and Page 2 (Payment) of the Program Registration Form, I am registering for the program start date listed above. I understand that once the registration form and payment is received, a seat will officially be reserved for me in the program.*
I further understand that both the Registration Fee and Tuition payment are fully refundable until I complete and submit the Enrollment Agreement, which will be e-mailed to me closer to the program start date. Once the Enrollment Agreement is submitted, the Registration Fee and tuition payment will follow the Refund Policy.*
To withdraw my registration, I understand that I MUST provide written notice to CAHE’s Admissions Department by e-mailing firstname.lastname@example.org. My registration will be withdrawn on the date that the written notice is provided.*
Registration fee of $ and the tuition enrollment of $ are due at this time.
Additional information regarding each program, including the program’s mission statement and goals, may be found on our website www.cahe.edu.
I certify that the information contained within this application is complete and accurate to the best of my knowledge and belief.*
2.75% credit card processing fee applies to all credit card transactions.
* By authorizing this transaction, customer agrees that merchant may convert this transaction into an Electronic Funds Transfer (EFT) transaction or paper draft, and to debit this account for the amount of the transaction. Additionally, in the event this draft or EFT is returned unpaid, a service fee, as allowable by law, will be charged to this account via EFT or draft. In the event that I choose to revoke this authorization, I will do so by contacting the merchant directly. Processing times may not allow for revocation of this authorization. Processing electronic check payment using insufficient funds or incorrect account information, will result in a fee of .05% of the total amount, if it doesn’t exceed $7,499. The fee of 0.1% will be incurred for payments over $7,500.
Center for Allied Health Education does not discriminate on the basis of race, sex, religion, national origin, age,
disability or marital status in its admissions and/ or employment policies.