Central Business School Enrollment Form

	Central Business School Experts in the business of healthcare for over 18 years!

Certificate Programs Enrollment Form
Payment Plans Now Available Here!

Applicant Name:

Street Address/PO Box:

City, State, Zip:

Phone:

Email:

Birth date:

Soc. Sec. #:

Health Information Coding Certificate Program (HICOD400)

$1395

Medical Records Coding Certificate Program (MCOD400)

$995

Medical Transcription Certificate Program (MTRN300)

$995

Medical Terminology Certificate Program (MTRM200)

$495

Human Anatomy Certificate Program (HANA200)

$495

Total:

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Expiration date:

Terms: All tuition and fees paid by the applicant shall be refunded if the applicant is rejected by the school before enrollment. An application fee of not more than $25.00 may be retained by the school 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. All refunds shall be returned in 30 days. Certificate is awarded upon successful completion of each certificate program. The recommended and allowable completion times for each certificate program are specified on the program pages. The allowable completion time for the MTRM200, HANA200, MTRN300, and MCOD400 programs is 24 weeks from date of enrollment. The allowable completion time for the Health Information Coding Certificate Program (HICOD400) is one year from the date of enrollment. Your signature below indicates you understand and agree to the terms of this enrollment agreement. Payment plans are available HERE.

Signature:

Date:

Please enroll by filling out this form,
signing the form,
and mailing with payment to:

Central Business School
PO Box 1081
Marquette, MI 49855

Use the PayPal option on the program pages,
if desired, to enroll online with PayPal or credit card.

Please also mail signed enrollment form
or email to info@centralbusinessschool.com
when registering via PayPal.

Questions?

Please email
Central Business School

Call 906.226.0169

Payment Plans Now Available Here!

Notice of Cancellation

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You may cancel this transaction, without penalty or obligation, within 3 business days from the above date.

To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice.

I hereby cancel this transaction:

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