Enrollment Form Printable Enrollment Form
| Applicant Name | |
| Street Address/PO Box | |
| City, State, Zip | |
| Phone: | |
| Date of Birth | |
| Soc. Sec. # (optional) | |
| Email: (optional) |
| Medical Terminology (MEDTRM100) (60 Hours) - $975 includes all books materials | |
| Human Anatomy (MEDANA200) (60 Hours) - $960 includes all books materials | |
| Medical Secretary/Receptionist (MEDSEC300) (72 Hours) - $1295 includes all books and materials | |
| Medical Billing/Coding (MEDBILLCOD400) (60 Hours) - $1295 includes all books and materials | |
| Medical Information
Internship (MEDINTERN) (60 hours) - $400 No books or materials required |
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| CCA Examination Prep and ADV Health Information and Coding (MEDBILLCOD500) (60 Hours) - $995 includes all books and materials | |
| CCS-P Examination Prep and ADV Physician Coding (MEDBILLCOD501) (60 Hours) - $1050 includes all books and materials | |
| CCS Examination Prep and ADV Hospital Coding (MEDBILLCOD502) (60 Hours) - $1060 includes all books and materials | |
| Medical Transcription (MEDTRN500) (60 Hours) - $975 includes all books and materials | |
| Medical Transcription
ADV (MEDTRN400ADV) (24 Hours) - $250 includes all books and materials |
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| RMT Examination Prep and Adv Transcription (MEDTRAN500) (60 Hours) - $950 includes all books and materials | |
| Medical Information Internship (MEDINTERN) (60 Hours) $400 No books or materials required | |
| 6-Hour Software Classroom Program - $150 includes all books and materials Indicate software (Word, Excel, Access, etc.): | |
| 12-Hour Software Classroom Program - $300 includes all books and materials- Indicate software (Word, Excel, Access, etc.): |
| Number of Check or Money Order Enclosed | |
| Amount of Check or Money Order Enclosed |
| Credit Card Type | VISA MC DISCOVER |
| Name on Credit Card | |
| Credit Card Number | |
| Expiration date | |
| Please mail enrollment form and payment
to: CAREER ACADEMY OF MARQUETTE |
Or fax credit card enrollments to 906.226.2743 |
| APPLICANT SIGNATURE: My signature here acknowledges that I have read and understood the tuition agreement below. |
DATE: |
TUITION AGREEMENT:
The certificate program book packages are assembled at the time of enrollment to provide the student with the most current materials. All enrollments are confirmed by email or phone call. All tuition and fees paid by the applicant shall be refunded if the school does not accept the student application. The school may retain an application fee of not more than $25.00 if the application is denied. All tuition and fees paid by the applicant shall be refunded if requested within three business days after signing a contract with the school. Once the 3 business days have elapsed no refunds will be given. All refunds shall be returned in 30 days. Certificate and transcript are awarded upon successful completion of each course and/or program.
