Cascadia - Dental Career Institute
2616 N.E. 112th Avenue Vancouver, Washington 98684

I have selected the following payment plan for the dental assisting course:

_____ $3995.00 paid on or before the first day of class.

_____ $500.00 down payment then $345.00 at the beginning of each class (11 payments) (This option will cost approximately 3 % more)

_____ Private Financing (Please provide me more information)

A $100.00 minimum application fee is required no later than one week prior to the start of each class with any of the above plans to guarantee your place in class. But remember we do fill up quickly and we take students on a first come first serve basis.

Please complete the following to reserve a place in our next class:

____payment in full $3995.00 ______Master Card ______Money Order

$ _________ down payment ____Check_______ Visa _______Discover

Credit card #________________________Exp. Date_____________

Name: ___________________________________________

Address____________________________

City_______________________State______Zip code__________

Phone Number; ____________________________________

Soc. Sec. #________________________________________

Birth date__________________________________________

Signature: ______________________________Date:_______

Cancellation Policy

You may cancel the enrollment agreement or contract by written or oral notice, without any penalty or obligation and receive a full refund of all monies paid within 72 hours until midnight of the third day, including Saturdays, excluding Sundays and legal holidays). After the enrollment, agreement or contract is signed and a tour of the facilities is made. The enrollment agreement is not binding until signed by the school director or designated school official.
An applicant, who has not visited the school, toured the school facilities and inspected the equipment prior to signing an enrollment contract has an additional three days to withdraw without penalty and request a full refund of any monies paid.

How did you find out about our course?

Newspaper_________ Former Student______ Other___________

© 2006 Cascadia Dental Career Institute