Sample Enrollment Agreement printable pdf download

SAMPLE ENROLLMENT AGREEMENT

This sample is provided to assist schools in developing an enrollment agreement for approval by the State

Council of Higher Education for Virginia (SCHEV). Please note that while schools may develop their

own enrollment agreement, the following sample contains the minimum information to be present in order

to obtain SCHEV approval.

Please be advised that this sample is only a suggestion for format and language. Any enrollment

agreement is a contract binding both the student and the school. You are advised to obtain independent

legal advice before developing a final agreement.

SCHOOL NAME

STREET ADDRESS

CITY, STATE ZIP CODE

OFFICE TELEPHONE NUMBER

FAX TELEPHONE NUMBER

WEBSITE

E-MAIL

STUDENT INFORMATION

STUDENT NAME: ____________________________________________________________________

ADDRESS: __________________________________________________________________________

CITY/STATE/ZIP: _____________________________________________________________________

TELEPHONE #’S: H:_______________________ C: _____________________ W:_________________

E-MAIL: _____________________________________________________________________________

SOCIAL SECURITY #: _________________________________________________________________

EMERGENCY CONTACT: _____________________________________________________________

RELATIONSHIP: _________________________________ TELEPHONE #: _____________________

PROGRAM INFORMATION

DATE OF ADMISSION: ____/____/____ PROGRAM/COURSE: ______________________________

MO. DAY

YR.

PROGRAM START DATE: ____________________ ANTICIPATED END DATE: _______________

FULL-TIME:

PART-TIME:

DAY

EVENING

DAYS/EVENINGS CLASS MEETS: (circle) M

Sat

Sun

TIME OF DAY/EVENING CLASS BEGINS: ______ TIME OF DAY/EVENING CLASS ENDS: ____

NUMBER OF WEEKS: __________ TOTAL CREDIT/CLOCK HOURS _________

(CIRCLE ONE)

Sample Enrollment Agreement