STUDENT FIRST AND LAST NAME: __________________________________________________
STREET ADDRESS: _______________________________________________________________
PHONE NUMBERS: CELL _______________________ WORK ____________________________
E-MAIL ADDRESS: _______________________________________________________________
DRIVER’S LICENSE/ID NUMBER: ____________________________________________________
SOCIAL SECURITY #: _____________________________________________________________
EMERGENCY CONTACT: __________________________________________________________
RELATIONSHIP: _________________________ PHONE #: ____________________________
PROGRAM NAME: DENTAL ASSISTING PROGRAM _______
ORTHODONTIC ASSISTING PROGRAM _______
PROGRAM START DATE (PLEASE, REFER TO ACADEMIC CALENDAR POSTED IN SCHOOL CATALOG AND CHOOSE A DATE):_____________________
PROGRAM / COURSE OBJECTIVES: PRODUCE WORK READY DENTAL ASSISTANTS
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.
12 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.
100-HOUR ORTHODONTIC INTERNSHIP MUST BE COMPLETED WITHIN FOUR MONTHS FROM THE DATE WHEN THE 12 ORTHODONTIC MODULES HAVE BEEN FINISHED. ORTHODONTIC INTERNSHIP CAN BE COMPLETED AT ANY OF THE FOUR ORTHODONTIC CLINICS LISTED IN THE ACADEMIC CATALOG. STUDENTS CAN ROTATE BETWEEN THE CLINICS TO FULFILL THE INTERNSHIP REQUIREMENT IN A TIMELY MANNER. INTERNSHIP FORMS MUST BE SIGNED AT THE END OF EACH INTERNSHIP DAY BY ORTHODONTIC ASSISTANT AND CLINIC MANAGER. INTERNSHIP FORMS MUST BE EMAILED TO PROGRAM COORDINATOR (ILDENTALCAREERS@GMAIL.COM) AT THE END OF EVERY OTHER WEEK OF THE INTERNSHIP.
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
5% DISCOUNT IF STUDENT PAYS TUITION IN FULL UPON SIGNING OF THIS AGREEMENT
DAP PAYMENT PLAN: $1000 DOWN PAYMENT UPON SIGNING OF THIS AGREEMENT, FOLLOWED BY 8 WEEKLY PAYMENTS OF $300.
OAP PAYMENT PLAN: $750 DOWN PAYMENT UPON SIGNING OF THIS AGREEMENT, FOLLOWED BY 5 WEEKLY PAYMENTS OF $225.
DAP AND OAP COMBINED PAYMENT PLAN: $1000 DOWN PAYMENT UPON SIGNING OF THIS AGREEMENT, FOLLOWED BY 10 WEEKLY PAYMENTS OF $364.20.
CHOOSE: CASH___ eCHECK___ CREDIT CARD (2% PROCESSING FEE APPLIES)___
________________FULL TUITION INCLUDES ALL BOOKS, SUPPLIES AND ANY MISCELLANEOUS EXPENSES
________________ DOWN PAYMENT, FOLLOWED BY _____________WEEKLY PAYMENTS
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#:________________
ILLINOIS DENTAL CAREERS DOES NOT OFFER FINANCIAL AID FOR TUITION ASSISTANCE.
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|
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.
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.
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:_____________________
Program Coordinator’s Signature___________
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
Top Dental Assisting and Orthodontic Assisting School in Chicago Area. The school of Illinois Dental Careers, approved by the Illinois Board of Higher Education, will prepare you for a successful future in the dental field.