6455 E. Johns Crossing, Ste. 175
Johns Creek, GA 30097
P. 1-800-380-8714 F. 1-678-550-5503
ENROLLMENT AGREEMENT (Revised 02/15)
Student Information
Parent / Guardian Information
Name:
Full Name:
Date of Birth:
Gender:
Social Security Number:
Address:
Male
Female
City:
State:
Address:
Country:
Day Phone #:
City:
State:
Evening Phone #:
Email Address:
Zip:
Country:
Day Phone #:
Evening Phone #:
Email Address:
Program Identification

High School Diploma Program (9th through 12th)
- Transcript Received
Transcript Pending

Credit Recovery Program
Payment Information - Personal
Payment Information - Card Details
Name of Cardholder:
Or Bank Account holder
Initial Payment:
Recurring Monthly Payment:
Billing Address:
City:
State:
Zip:
Country:
Day Phone #:
Evening Phone #:
Email Address:
o
I certify that the credit card/Bank Account information
provided in this Enrollment Agreement is in my name. I
authorize National High School to charge my credit
card/bank account for the enrollment fee and recurring
monthly payment. I understand that this authorization
will be in force until cancelled in writing.
Card/Bank Account Owner’s Signature:
o
Payment Type:
E-Check
Bank Name:
Account # :
ABA Routing #:
Debit/Credit Card
Card #:
Security Code
Exp. Date:
Billing Address
City, State, Zip
Card Type:
Visa
MasterCard
Discover
American Express
- Recurring payment to be charged each following month on the:
5th - If enrolled by 10th
15th - If enrolled between 11th& 20th
25th- If enrolled between 21st&24th
5thof 2nd following month- If enrolled between 25th& 31stuntil
completion of the program.
Admissions Information
Name of Admissions Executive:
Date:
Source of Referral:
TERMS
AGREEMENT:
This contract correctly sets forth the entire agreement between the student, parent and/or guardian. No agreement or understandings shall be binding on
either of the parties hereto unless specifically set forth in this contract or subscribed to by the parties hereto in writing.
DIPLOMA and TRANSCRIPTS:
Upon satisfactory completion of a program of study and/or graduation requirements, the student is issued a Diploma in recognition of graduation and/or a
transcript reflecting the credits attempted and completed. The school may withhold a student’s diploma and/or transcripts until the student has fulfilled
his/her financial obligation to the school.
NONDISCRIMINATION POLICY:
NationalHigh School is in compliance with all requirements imposed by or pursuant to Title VI of the Civil Rights Act of 1964 and section 504,
Rehabilitation Act of 1973. NationalHigh School does not discriminate on the basis of race, color, religion, sex, or national origin in its activities, programs,
or employment policies, in accordance with Federal, State, and local laws.
NationalHigh School observes FERPA, the Family Educational Rights and Privacy Act.
INTERNATIONAL STUDENTS:
All instruction is conducted in English. International students will be required to pay postage costs for mailings which are requested by the student.
PAYMENT:
A student is enrolled into National High School’s program by paying a registration fee of $99. Tuition fee of $150 each month is due on the aforementioned
dates based on the date of enrollment. The administrative department requires up to seven (7) business days to setup a student’s virtual environment. The
applicant or parent hereby agrees to make acceptable payment arrangements with NationalHigh School based upon individual circumstances and enrollment
date. These arrangements may include: Credit Card (Mastercard, VISA, American Express, and Discover); Check, Cashier’s Check, Bank wire, Money
Order; and/or Non-Federal Student Loans. By agreeing to these terms and conditions, National High School is authorized to charge your credit card or Bank
Account $150 monthly until the program is completed or until the student opts to withdraw from the program. If a payment is not made on the due date,
the individual is subject to a $50 late fee.
ADMINISTRATIVE PROCESS:
The student understands that there is a seven (7) day administrative period once enrolled into the program, in which time the IT department and the Student
Services Department work to set up the virtual learn center. Upon completion of any given assignment or exam, the academic department scores all
submitted materials within seven (7) to ten (10) business days. The student is considered completed ONLY when all grades for assignments and exams
have been posted to the course. Students will maintain their student status until that period and are fully responsible for all financial obligations. If the
student formally withdraws or ceases to meet their financial obligation, grade report and transcripts will not be issued.
ARBITRATION: The parties agree to submit any disputes arising from this agreement to final and binding arbitration under the Rules of the American
Arbitration Association.
REFUND AND WITHDRAWAL POLICY: If a student cancels within 3 calendar days after midnight of the day the student enrolls (for this
purpose the date of initial payment is considered the date of enrollment), the student will receive a FULL refund with NO further obligation.
Thereafter the initial payment of $99 is non-refundable. Subsequently, a student may withdraw at any time during the course of program. If the intent to
withdraw is not conveyed to the Administrative Department by filling out a Status Change/Withdrawal Form at least 5 days before the payment due date,
then the student will be liable to pay monthly tuition of $150. Any refunds due will be processed within 30 days.
REFUND AND WITHDRAWAL POLICY FOR STUDENTS ENROLLED IN INDIVIDUAL COURSES: Tuition for 1 credit is $399 and 0.5
Credit is $250. A student can cancel the enrollment at any time. If a student cancels within 3 calendar days after midnight of the day the student
enrolls (for this purpose the date of initial payment is considered the date of enrollment), the student will receive a FULL refund with NO further
obligation. If a student cancels after the Full Refund Period but before the school receives the first assignment, the student will be refunded all money paid,
less an administrative fee of $200. Thereafter, all refunds are subject to administrative fee and tuition for any commenced course. The intent to
cancel/withdraw has to be conveyed to the Administrative Department by filling out a Status Change/Withdrawal Form. Any refunds due will be processed
within 30 days. Right to a refund will be terminated 90 days from the date of enrollment.
FTC DISCLOSURE STATEMENT: NOTICE: ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS
AND DEFENSES WHICH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT
HERETO OR WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID
BY THE DEBTOR HEREUNDER.
Student Name:
Signature:
Date:
Parent Name:
Signature:
Date: