Student’s Name: ___________________Date of Birth (Day and Mo.)______________
Address_______________________________________________________________________
Home Phone   (        ) ____________________Work Phone    (        ) ____________________
Email address ____________________________Fax Number   (       ) _____________________
How did you hear of the school? __________________________________________________

Program/Course Data: Hypnotic-Coaching Distance Learning Certification (maybe used as CEUs for hypnotherapy or a new modality of hypnosis) Total Hours: 150

 Start Date: __________________Completion: __________________
 
Type of Instruction: Self paced, Mentoring phone and email support, Practicum and Exam

Tuition and Fees:

1. School Administration: (included in distance Learning Tuition)

Tuition: $2400

Schedule of Payments;                                                               
Enrollment Deposit: $600 + Monthly payments of $300 to total $2400

Deposit______________________

Payments:
Date: _______ Date: _______  Date: _______ Date:  _______ Date;________ Date:  _______ 

By signing below, the student agrees to pay Colorado Coaching and Hypnotherapy Training Institute, hereinafter referred to as the school, the total stated tuition and fees.  The school agrees to provide the occupational training in accordance with the provisions of Catalog Volume X 2009.  Payment of all monies due shall be a condition of continuing enrollment.  Upon Satisfactory completion of all academic and skill requirements and when all financial obligations to the school have been met, the school will award a  Hypnotic-Coach Certification  The student and school understand that this enrollment agreement, WHICH INCLUDES THE REFUND POLICY may not be amended except in writing signed by both parties.

Postponement of Start Date

Postponement of a starting date, whether at the request of the school or the student, requires a written agreement signed by the student and the school. The agreement must set forth: A. Whether the postponement is for the convenience of the school or the student, and: B. A deadline for the new start date, beyond which the start date will not be postponed. If the course is not commenced, or the student fails to attend by the new start date set forth in the agreement, the student will be entitled to an appropriate refund of prepaid tuition and fees within 30 days of the deadline of the new start date set forth in the agreement, determined in accordance with the school’s refund policy and all applicable laws and rules concerning the Private Occupational Education Act of 1981.

Refund Policy

Students not accepted by the school and students who cancel this contract by notifying the school within three business days are entitled to a full refund of all tuition and fees paid  minus the School Administration fee of $200 (if paid) and the $150 cancellation fee. In the case of students withdrawing after commencement of classes, the school retains the School Administration fee of $200 (if paid) and the $150 cancellation fee plus a percentage of tuition which is based on the percentage of contact hours attended, as described in the table below.  The refund is based on the last date of recorded attendance. The student will retain the books. For Distance Learning there is no refund policy.

                                            REFUND TABLE

And the School Administration fee of $100  and the $150 cancellation fee

1. The student may cancel this contract at any time prior to midnight of the third business day after signing this Contract.
2. The official date of termination for refund purposes is the last date of recorded attendance.  All refunds will be made within 30 days from the date of termination.

a. The date on which the school receives notice of the student’s intention to discontinue the training program; or
            b. The date on which the student violates published school policy, which provides for termination.
c. Should a student fail to return from an excused leave of absence, the effective date of termination for a student on an extended leave of absence or a leave of absence is the earlier date the school determines the student is not returning or the day following the expected return date.

1. The student will receive a full refund of tuition and fees paid if the school discontinues a course/program within a period of time a student could have reasonably completed it, except that this provision shall not apply in the event the school ceases operation.
2. Complaints, which cannot be resolved by direct negotiation between the student and the school may be filed with the Division of Private Occupational Schools of the Colorado Department of Higher Education 1380 Lawrence St., Suite 1200, Denver, CO 80204 303-894-2960. There is a two year limitation on the Division taking action on student complaints.
3. The policy for granting credit shall not impact the refund policy

Print name as you want it on your certificate:________________________________________________
      
____________________________________________             Date____________________
        Student Signature                                                                                  
             Zoilita Grant MS. CCHt. CHC.                                   _Date: 12/14/09
            Certified Hypnotic-Coach
               School's Licensed Agent                                                                
 
Master Card/Visa #___________________________
 Expiration Date ________________CODE________
Name and Address on c.c  if different from student’s address_____________________________

______________________________________________________________________________
You may call 303-776-6103 with c.c#