Enrollment Agreement

ILLINOIS DENTAL CAREERS
4709 N. HARLEM AVE.
HARWOOD HEIGHTS, IL 60706
Phone: 224-246-2694
Email: ILDENTALCAREERS@GMAIL.COM
Website: WWW.ILLINOISDENTALCAREERS.COM

ENROLLMENT AGREEMENT

STUDENT INFORMATION:

STUDENT FIRST AND LAST NAME: __________________________________________________

STREET ADDRESS: _______________________________________________________________

CITY/STATE/ZIP: _________________________________________________________________

PHONE NUMBERS: CELL _______________________   WORK ____________________________

E-MAIL ADDRESS: _______________________________________________________________

DRIVER’S LICENSE/ID NUMBER: ____________________________________________________

SOCIAL SECURITY #: _____________________________________________________________

EMERGENCY CONTACT: __________________________________________________________

RELATIONSHIP: _________________________        PHONE #: ____________________________

PROGRAM INFORMATION:

PROGRAM  NAME:    DENTAL ASSISTING PROGRAM              _______     

                                     ORTHODONTIC ASSISTING PROGRAM _______

PROGRAM START DATE (PLEASE, REFER TO ACADEMIC CALENDAR POSTED IN SCHOOL CATALOG AND CHOOSE A DATE):_____________________

ADMISSION REQUIREMENTS:

  • ALL ILLINOIS DENTAL CAREERS APPLICANTS MUST BE 18 YEARS OR OLDER BY THE TIME OF THEIR PROGRAM COMPLETION.

PROGRAM / COURSE OBJECTIVES:  PRODUCE WORK READY DENTAL ASSISTANTS

DENTAL ASSISTING PROGRAM DESCRIPTION:

20 MODULES/2.5 HOURS EACH, OFFERED ON TWICE A WEEK IN THE EVENING (PLEASE, REFER TO ACADEMIC CALENDAR, POSTED IN SCHOOL CATALOG, FOR DETAILS), EACH INCLUDE THEORETICAL AND CLINICAL COMPONENTS, COVERING DENTAL AND ORAL ANATOMY AND PHYSIOLOGY, CHAIRSIDE ASSISTING, RADIOLOGY, IMPRESSIONS, INSTRUMENT IDENTIFICATION, RESTORATIVE MATERIALS AND PROCEDURES, LAB MATERIALS AND TECHNIQUES, CORONAL POLISHING, PIT AND FISSURE SEALANTS PLACEMENT, INFECTION CONTROL, STERILIZATION, AND ASSISTING IN DENTAL SPECIALTIES.

ORTHODONTIC ASSISTING PROGRAM DESCRIPTION:

14 MODULES /2.5 HOURS EACH, OFFERED ON SATURDAYS (PLEASE, REFER TO ACADEMIC CALENDAR, POSTED IN SCHOOL CATALOG, FOR DETAILS), INCLUDE THEORETICAL AND CLINICAL COMPONENTS, COVERING ADVANCED DENTAL AND ORAL ANATOMY AND PHYSIOLOGY, BASIC TO ADVANCED ORTHODONTIC CHAIRSIDE ASSISTING, ORTHODONTIC MATERIALS AND SUPPLIES, INSTRUMENTS AND PROCEDURES, APPLIANCES, INVISALIGN, RADIOLOGY AND IMPRESSIONS.

ATTENDANCE POLICY:

ILLINOIS DENTAL CAREERS OPERATES ON A ROLLING ADMISSION BASIS, WHERE STUDENTS CHOOSE THE START AND END DATES OF THEIR PROGRAMS, AS WELL AS THEIR OWN PACE OF STUDYING. THE ONLY REQUIREMENT FOR STUDENTS IS TO COMPLETE AT LEAST ONE PROGRAM MODULE EVERY TWO WEEKS IN ORDER TO STAY ACTIVE IN THE PROGRAM. IF THE STUDENTS MISS A MODULE DURING THE WEEK, THEY CAN WAIT UNTIL THIS MODULE IS OFFERED AGAIN DURING THE WEEK IN THE NEXT ACADEMIC CALENDAR CYCLE AND TAKE IT AT THAT TIME.

PROGRAM COMPLETION REQUIREMENTS

  • STUDENTS MUST COMPLETE ALL OF THE ASSIGNED MODULES IN THEIR PROGRAMS.
  • STUDENTS MUST ATTAIN AT LEAST A 70% FINAL GRADE IN THEIR PROGRAMS.

TUITION AND FEES:

DENTAL ASSISTING PROGRAM (DAP):              $2,900

ORTHODONTIC ASSISTING PROGRAM (OAP): $1,500

DAP AND OAP COMBINED:                                 $3,900

TUITION INCLUDES ALL OF THE FOLLOWING:

  • Printed instructional materials and handouts
  • Training materials and dental supplies
  • Access to state-of-the art technology
  • Letter of Recommendation for students who have achieved a 85% or above grade point average
  • Dental/Orthodontic Assisting Certificate
  • Dental Assistant’s Pin
  • Clinical fees

5% DISCOUNT IF STUDENT PAYS TUITION IN FULL UPON SIGNING OF THIS AGREEMENT

DAP PAYMENT PLAN: $900 DOWN PAYMENT UPON SIGNING OF THIS AGREEMENT, FOLLOWED BY 6 WEEKLY PAYMENTS OF $330.

OAP PAYMENT PLAN: $500 DOWN PAYMENT UPON SIGNING OF THIS AGREEMENT, FOLLOWED BY 5 WEEKLY PAYMENTS OF $200.

DAP AND OAP COMBINED PAYMENT PLAN: $900 DOWN PAYMENT UPON SIGNING OF THIS AGREEMENT, FOLLOWED BY 10 WEEKLY PAYMENTS OF $300.   

FINANCIAL ARRANGEMENTS:

CHOOSE: CASH___   eCHECK___   CREDIT CARD (2% PROCESSING FEE APPLIES)___

________________DISCOUNT

________________FULL TUITION INCLUDES ALL BOOKS, SUPPLIES AND ANY MISCELLANEOUS EXPENSES

________________ DOWN PAYMENT, FOLLOWED BY _____________WEEKLY PAYMENTS

eCHECK:

NAME ON CHECKING ACCOUNT:____________________________________________

9-DIGIT ROUTING NUMBER: ______________________________________________

ACCOUNT NUMBER: _____________________________________________________          

CHECK NUMBER: ________________________________________________________    

CREDIT CARD (2% PROCESSING FEE APPLIES):

CREDIT CARD NUMBER:______________________________ EXP. DATE:________________

AMOUNT TO BE CHARGED $___________________________       CVV#:________________

CARDHOLDER’S NAME:_______________________________________________________

CARDHOLDER’S SIGNATURE:___________________________________________________     

FINANCIAL AID:

ILLINOIS DENTAL CAREERS DOES NOT OFFER FINANCIAL AID FOR TUITION ASSISTANCE.

REFUND/CANCELLATION POLICY:

Illinois Dental Careers shall, when a student gives a written notice of cancellation, provide a refund in the amount of at least the following:
  • When a notice of cancellation is given before midnight of the fifth business day after the date of enrollment but prior to the first day of class attendance by the student, 100% of tuition, and any other charges shall be refunded to the student;
  • When notice of cancellation is given after midnight of the fifth business day following the date of enrollment but prior to the close of business on the student’s first day of class attendance, 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;
  • Applicants not accepted by the school shall receive a refund of all tuition and fees paid within 30 calendar days after the determination of non-acceptance is made.
  • Deposits or down payments shall become part of the tuition.
  • The school shall mail a written acknowledgement of a student’s cancellation or written withdrawal to the student within 15 calendar days of the postmark date of notification. Such written acknowledgement is not necessary if a refund has been mailed to the student within the 15 calendar days.
  • All student refunds shall be made by the school within 30 calendar days from the date of receipt of the student’s cancellation.
  • Students must complete at least one module every two weeks to stay in the program. Not completing at least one module every two weeks shall constitute a constructive notice of cancellation to the school. For purposes of cancellation the date of cancellation shall be the last day of attendance.

Should the student’s enrollment be terminated or should the student withdraw for any reason, all refunds will be made according to the following refund schedule:

Number of Modules completed Refund amount (% of tuition)
1 100% minus registration fee of $150
2 90% tuition
3 80% tuition
4 70% tuition
5 60% tuition
6 50% tuition
7 40% tuition
8 30% tuition
9 20% tuition
10 10% tuition
11 0% tuition
12 0% tuition
13 0% tuition
14 0% tuition
15 0% tuition
16 0% tuition
17 0% tuition
18 0% tuition
19 0% tuition
20 0% tuition

NOTICE TO STUDENT

  • Do not sign this agreement before you have read it or if it contains any blank spaces.
  • 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.
  • You are entitled to an exact copy of the agreement and any disclosure pages you sign.
  • This agreement and the school catalog constitute the entire agreement between the student and the  school.
  • 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.
  • 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 midnight of the 5th business day after the student has been accepted by the school. If the right to cancel is not given to any prospective student at 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 30 days of cancellation. Cancellations should be delivered in writing to the school management.

STUDENT ACKNOWLEDGMENTS

  • 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. Student Initials ______
  • I have carefully read and received an exact copy of this enrollment agreement. Student Initials ______
  • 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. Student Initials ______
  • 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. Student Initials ______
  • 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,  [school  name]  must  provide  me  copies  of  transfer  agreements  that  name  the  exact  institution(s) and include agreement details and limitations.   Student Initials ______
  • I  understand  that  the  school  does  not  guarantee  job  placement  to  graduates  upon  program  completion. Student Initials ______
  • 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,  1 N Old State Capitol Plaza Suite 333, Springfield, IL 62701 or at www.ibhe.org.  Student Initials ______

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.

INSTITUTIONAL DISCLOSURES

  • The number of students who were admitted in the Dental Assisting Program as of July 1 of this reporting period: 19. The number of students who were admitted in the Orthodontic Assisting Program as of July 1 of this reporting period: 4.
  • The number of additional students who were admitted in the Dental/Orthodontic Assisting Programs during the next 12 months and classified in one of the following categories: a) Dental Assisting Program, new starts: 19. Orthodontic Assisting Program, new starts: 4. b) Re-enrollments: 0. c) Transfers into the program from other programs at the school: 0.
  • The total number of students admitted in the Dental Assisting Program during the 12-month reporting period: 19.  The total number of students admitted in the Orthodontic Assisting Program during the 12-month reporting period: 4.
  • The number of students enrolled in the programs during the 12-month reporting period who: a) Transferred out of the program or course and into another program or course at the school: 0. b) Completed or graduated from the Dental Assisting program: 13. Completed or graduated from the Orthodontic Assisting program: 0. c) Withdrew from school: 0. d) Are still enrolled in the Dental Assisting program: 6. Are still enrolled in the Orthodontic Assisting program: 4.
  • The number of students enrolled in the Dental Assisting Program who were: a) Placed in their field of study: 6. b) Placed in a related field: 1. c) Placed out of the field: 0. d) Not available for placement due to personal reasons: 0. e) Not employed: 0.   The number of students enrolled in the Orthodontic Assisting Program who were: a) Placed in their field of study: 0. b) Placed in a related field: 0. c) Placed out of the field: 0. d) Not available for placement due to personal reasons: 0. e) Not employed: 0.
  • The  number of students who took a State licensing examination or professional certification examination, if any, during the reporting period: 0
  • The  number of students who took and passed a State licensing examination or professional certification examination, if any, during the reporting period: 0
  • The number of graduates who obtained employment in the field who did not use the school’s placement assistance during the reporting period: 4.
  • The average starting salary for all school graduates employed during the reporting period: $14.00/HR.

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 Signature:_____________________

Date:_______________

Program Coordinator’s Signature___________

Date: ______________

ILLINOIS HEALTH CAREERS DBA ILLINOIS DENTAL CAREERS WAS APPROVED BY THE DIVISION OF PRIVATE BUSINESS AND VOCATIONAL SCHOOLS OF THE ILLINOIS BOARD OF HIGHER EDUCATION WITH NO ACCREDITATION FROM INSTITUTIONS RECOGNIZED THROUGH THE U.S. BOARD OF EDUCATION

Copyright 2017 Illinois Dental Careers . All rights reserved.