Student Name: _______________________________________
Student I.D Number: _______________________________________
Telephone (home): _______________________________________
Cell Phone: _______________________________________
Date of Birth: _______________________________________
E-mail: _______________________________________
Program: CPC Training Program
Starting and ending dates- Two online course a yea, first course runs January through
May and second course runs July through November.
Time Required: Classes will be held every Saturday for 4 hours, duration of online
course to be completed within 20 weeks or less, 80 total clock hours only for time spent
in the online course and does not include time spent outside the course or study time.
Study time will vary widely per individual
Class Schedule- Every Saturday for 4 hours (9am-12 noon)
The total cost for the CPC Training Program:
Tuition: $2,650.00
Exam Fee $325.00
Total Program Costs $2,975.00
Please note that the Tuition fees includes cost of code books, course materials, online
access fee, AAPC membership, CPC exam, and training with a live instructor.

______ Student initials
1. A payment of $1,325.00 is due with signing of this enrollment agreement and
acceptance into the online training course.
2. Balance of tuition options:
2.1 Installments of $66.25 weekly; or
2.2 Installments of $132.50 bi-weekly.
3. Klarna is another acceptable payment method.

If for any reason an applicant is not accepted by the school, the applicant is entitled to a
refund of all monies paid.
Withdrawal by the Student: Students can withdraw at any time of the course by
contacting the school via telephone and or email. Code books, online access fee,
course materials, and AAPC membership are non-refundable. CPC exam fee is
refundable if student withdraws within 30 days of the course start date.
Termination by the School: Students may be terminated by school due to academic
progress, non-payment, failure to comply with conduct policy, attendance policy and all
other published school policies.
Refund after the commencement of classes:

1. Procedure for withdrawal/withdrawal date:
1.1 A student choosing to withdraw from the school after the commencement of
classes is to provide written notice to the Director of the school. The notice is to
indicate the expected last date of attendance and be signed and dated by the
1.2 For a student who is on authorized Leave of Absence, the withdraw date is
the date the student was scheduled to return from the Leave and failed to do
1.3 A student will be determined to be withdrawn from the institution if the student
has not attended any class for 20 Clock Hours.
1.4 All refunds will be issued within 30 days of the determination of the
withdrawal date.
2. Tuition charges/refunds:

______ Student initials
A. Before the beginning of classes, the student is entitled to a refund of 100%
of the tuition, minus the Exam fee of $325.00.
B. After the commencement of classes, the tuition refund will be determined
as follows:
i. Students will be refunded for the CPC exam fee of $325.00 if withdrawn within 30
days of the course start date.
ii. The Tuition fees will be refunded as according to the following schedule:
% of the clock hours attempted: Tuition refund amount:
10% or less 90%
More than 10% and less than or equal to 20% 80%
More than 20% and less than or equal to 30% 70%
More than 30% and less than or equal to 40% 60%
More than 40% and less than or equal to 50% 50%
More than 50% No Refund is required
The percentage of the clock hours attempted is determined by dividing the total number
of clock hours elapsed from the student’s start date to the student’s last day of
attendance, by the total number of clock hours in the program.
Books, supplies and fees: Identify what if any of these costs as specified on the
enrollment agreement are refundable and under what terms and conditions.
Refunds will be issued within 10 days of the date of student notification.
Although Myers Medical Coding Edu does not provide a job placement service, the
school will write letters of recommendation for every student which can be used as a
professional reference
1. The School does not accept credit for previous education, training, or work
experience (experimental learning).
2. The School does not guarantee job placement to graduates upon
program/course completion.
3. The School reserves the right to reschedule the program start date when the
number of students scheduled is too small.
4. The School will not be responsible for any statement of policy or procedure that
does not appear in the School catalog.
5. The School reserves the right to discontinue the student’s training for
unsatisfactory progress, non-payment of tuition or failure to abide by School rules

______ Student initials
6. Information concerning other Schools that may accept the School’s credits toward
their programs can be obtained by contacting the office of the President. It should
not be assumed that any programs described in the School catalog could be
transferred to another institution. The School does not guarantee the transferability
of credits to a college, university or institution. Any decision on the comparability,
appropriateness and applicability of credits and whether they should be accepted is
the decision of the receiving institution.
7. This document does not constitute a binding agreement until accepted in writing
by all parties.
1. I hereby acknowledge receipt of the School’s CPC Preparation Course Syllabus
dated __________________ which contains information describing programs
offered, and equipment/supplies provided. The School’s CPC Preparation
Course Syllabus is included as a part of this enrollment agreement, and I
acknowledge that I have received a copy of this catalog. ______ Student initials
2. Also, I have carefully read and received an exact copy of this enrollment
agreement. ______ Student initials
3. I understand that the School may terminate my enrollment if I fail to comply with
attendance, academic and financial requirement or if I disrupt the normal
activities of the School. While enrolled in the School. I understand that I must
maintain Satisfactory Academic Progress as described in the School catalog and
that my financial obligation to the School must be paid in full before a certificate
may be awarded. ______ Student initials
4. I also understand that this institution does not guarantee job placement to
graduates upon program/course completion or upon graduation. ______ Student
I, the undersigned, have read and understand this agreement and acknowledge receipt
of a copy. It is further understood and agreed that this agreement supersedes all prior or
contemporaneous verbal or written agreements and may not be modified without the
written agreement of the student and the School Official. I also understand that if I
default upon this agreement I will be responsible for payment of any collection fees or
attorney fees incurred by MYERS MEDICAL CODING EDU.
My signature below signifies that I have read and understand all aspects of this
agreement and do recognize my legal responsibilities in regard to this contract.
Signed this _______day of_______ 20____
__________________________ ____________________

______ Student initials

Signature of Student Date
_________________________ ____________________
Signature of MMC Official Date
Representative’s certification: I hereby certify that__________________________ has
been interviewed by me and in my judgment, meets all requirements for acceptance as a
student. I further certify that there have been no verbal or written agreements or
promises other than those appearing on this agreement.
By: _________________________________ Date: __________________

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