Online Enrollment Agreement - Martinsburg College

Enrollment Agreement
Martinsburg College
341 Aikens Center
Martinsburg, WV 25404
Tel. (304) 263-6262
https://martinsburgcollege.edu

* First Name:	* Last Name:
Maiden Name(If Applicable):	* SSN:
* Address of Current Location*:	Apt/Unit:
*Students are required to inform the institution of any change of address during their program.
* City:	* State:
* Country:	* Zip/Postal Code:
* Cell Phone #:	Home Tel.:
* I agree to receive text messages sent to my mobile phone. (Message & data rates may apply.)	Work Tel.:	Extension:
* Date of Birth:	* Gender:
* Email Address 1:	Email Address 2:

	* Have you taken a program at Martinsburg College in the past?
	* Are you military-affiliated?
	* Is this your first time enrolling at Martinsburg College?
	* Branch of Service:				Rank:
	* Military Job Title/MOS:				Civilian Job Title:
	* End of Active Service Date (for Military Service Members):

	The federal government requires postsecondary educational institutions to collect data on race and ethnicity for reporting purposes only. Please respond to the following questions:

	* Are you Hispanic or Latino?
	* Please select one or more of the categories listed below with which you identify:

		American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Nonresident alien Race and ethnicity unknown

	* Have you ever attended (regardless of completion) a college or university or other training/vocational school after high school?
	* Are you a high school graduate or earned a GED?
	* Are you enrolling at Martinsburg College within 12 months of graduating high school or receiving your GED?

I am hereby enrolling in the academic program outlined below and my enrollment is subject to the terms and conditions stated in this enrollment agreement.

Program Enrollment
*Program Selected:		Number of Credits:
Total Program Price: $
*Preferred Start Date:		Scheduled End Date:

* Method of Payment:
Corporate Billing Credit Card Check Tuition Assistance MYCAA G.I. Bill Funding
Federal Student Aid Institutional Payment Plan/Institutional Loan Income Share Agreement Private Loan Other: *If Other, please specify.
(If method of payment is T.A., school will invoice branch of service/company directly upon receipt of an approved tuition assistance authorization.)

The following information applies to California-based students:

The State of California established the Student Tuition Recovery Fund (STRF) to relieve or mitigate economic loss suffered by a student in an educational program at a qualifying institution, who is or was a California resident while enrolled, or was enrolled in a residency program, if the student enrolled in the institution, prepaid tuition, and suffered an economic loss. Unless relieved of the obligation to do so, you must pay the state-imposed assessment for the STRF, or it must be paid on your behalf, if you are a student in an educational program, who is a California resident, or are enrolled in a residency program, and prepay all or part of your tuition

You are not eligible for protection from the STRF and you are not required to pay the STRF assessment, if you are not a California resident, or are not enrolled in a residency program.

Cancellation Policy

A student has five (5) calendar days after signing an enrollment agreement to cancel enrollment in any manner and receive a full refund of all monies paid to the institution. In addition, students enrolling in undergraduate credit-bearing programs may cancel their enrollment up to the completion of the first course in the program and receive a full refund of all monies paid to the institution.

For non-credit bearing undergraduate programs, a student requesting cancellation more than five calendar days after signing an enrollment agreement, but prior to beginning a course or program, is entitled to a refund of all monies paid minus a one-time administrative fee per program of no more than 20 percent of the tuition and not to exceed more than $200 per program.

Refund Policy:

When a student cancels after completing at least one assignment but less than 50 percent of the graded assignments, the institution may retain the administrative fee of no more than 20 percent of the tuition, not to exceed $200 per program, plus a percentage of tuition paid by the student in accordance with the following schedule:

Percentage Completed by the Student	Percentage of Tuition Returned to the Student (or Third-Party Funding Agency) Minus the Administrative Fee	Percentage of Tuition Retained by the Institution
Up to 10%	90%	10%
>10% - 25%	75%	25%
>25% - 50%	50%	50%
>50% - 100%	0%	100%

Sample Refund Calculation:

Total Number of Graded Assignments = 25

For students who complete 2 out of the 25 graded assignments: 2/25 = 8%

Tuition = $4500 – $200 administrative fee = $4300 x 10% = $430.00 + $200 administrative fee = $630. Total retained by the institution = $630. Total returned = $3870.

For students who complete 6 out of the 25 graded assignments: 6/25 = 24%

Tuition = $4500 – $200 administrative fee = $4300 x 25% = $1075 + $200 administrative fee = $1275. Total retained by the institution = $1275. Total returned = $3225.

For students who complete 12 out of the 25 graded assignments: 12/25 = 48%

Tuition = $4500 – $200 administrative fee = $4300 x 50% = $2150 + $200 administrative fee = $2350. Total retained by the institution = $2350. Total returned = $2150.

For students who complete 20 out of the 25 graded assignments: 20/25 = 80%

Tuition = $4500 – $200 administrative fee = $4300 x 100% = $4300 + $200 administrative fee = $4500. Total retained by the institution = $4500. Total returned = $0.

Refunds will be made within 20 days after receipt of a written notification of withdrawal or within 30 days of a cancellation or withdrawal request made in any manner. If no notification of termination is received by the school, refunds will made within thirty (30) days of the date of determination that the student has withdrawn from the program.

Students have the right to withdraw from the program at any time. However, the refund period ends in conjunction with the initial enrollment termination date which is located below. If you do not complete your program within the time allotted prior to the termination date of the enrollment agreement, no refund will be issued. The termination date of this enrollment agreement is 1.5 times the scheduled enrollment period which is .

General Information
All students must read and sign the Equipment Return Policy prior to starting their course. Courses are offered via distance learning. The student has the right to withdraw from the program at anytime. The student has the responsibility of informing the institution that s/he wants to withdraw. All equipment and materials on loan to the student must be returned to the institution at the time of withdrawal or the student will be billed for their replacement cost. (Please see the Equipment Return Policy.) The student has the responsibility for maintaining the academic schedule and submitting required coursework on time. The institution has the responsibility to support the student`s academic program and to communicate to the student his/her academic progress. For students utilizing Federal Student Assistance (FSA) funds, please review the Consumer Disclosure information. For students interested in utilizing an Institutional Payment Plan/Institutional Loan, please click here for disclosure information. Students who choose to utilize an institutional loan will be required to sign a Retail Installment Contract (RIC) in addition to the Enrollment Agreement. Please click here for a sample Retail Installment Contract.

Student Grievance/Complaint Procedure
Martinsburg College is committed to providing a learning environment that promotes student success and achievement. If students are not satisfied with any aspect of their program or the institution, they may contact the Student Services department at (304) 263-6262 ext. 2 or by email at [email protected]

Most issues can be resolved quickly once the institution is aware of the student’s concern. Martinsburg College is committed to resolving students’ concerns and issues. In the event that the issue is still not resolved after communication with the Student Services department, students may contact Ms. Lori Charbonnier and file a complaint. Complaints can be made in writing, via email or by telephone to Ms. Charbonnier at:
Lori Charbonnier
Student Services
Martinsburg College
341 Aikens Center
Martinsburg, WV 25404
Telephone (304) 607-4039
[email protected]

Student complaints typically are about items such as administrative issues, technical issues, faculty performance, grading, program content, program effectiveness/expectations, and/or library services. The complaint should outline the nature of the complaint and the parties involved. The written complaint should include:
1) Student’s name 2) Current address 3) Current phone number 4) Current email address 5) A description of the complaint including pertinent details of any previous conversations with school personnel 6) Copy of any documents necessary for full understanding of the complaint 7) Expectation for how the complaint should be resolved.

Ms. Charbonnier will contact the student directly within 72 hours of receipt of a complaint. If the complaint is unable to be resolved by Ms. Charbonnier, the complaint will be forwarded to the Chief Academic Officer & Director of Operations. The Chief Academic Officer & Director of Operations will conduct an investigation into the complaint and will respond in writing within 10 business days of its receipt. If the complaint concerns a faculty member or administrator, the institution will allow the faculty member or administrator 10 business days to respond to the complaint. The student will be informed of this timeframe. The institution will make a final decision after receiving the responses from all involved parties. If, after following these procedures, astudent still feels that his/her complaint has not been addressed satisfactorily, s/he may contact the West Virginia Council for Community and Technical College Education, 1018 Kanawha Blvd. East, Suite 700, Charleston, WV 25301 (304) 558-0265 or The Distance Education Accrediting Commission, 1101 17th Street, N.W., Suite 808, Washington, D.C. 20036 (202) 234-5100.

Martinsburg College cannot guarantee the transferability of credits to a college, university or institution. The acceptance of credits/coursework earned at Martinsburg College is determined by the receiving institution.

* I confirm that I have reviewed the Standardized Cost Form.

* I confirm that I have reviewed the Personalized Shopping Sheet and the information sheet for students utilizing Veterans benefits.

* I confirm that I have reviewed the .

* I confirm that I have earned a High School Diploma or equivalent.

* I authorize Martinsburg College to release and forward course enrollment information including course withdrawal, course cancellation, course completion or failure, grade, verification of degree or certificate completion, billing information, and any other required information to the Department of Defense and/or the TA issuing Service`s education office or funding agency.

* By checking this box, I am signing that I, , understand and agree to comply with the terms and conditions of this enrollment agreement, including the Cancellation and Refund Policy. I affirm that I have received access to the catalog and the complaint policy. I understand the rights, responsibilities, and obligations of both the student and the institution. I understand that this contract is legal and binding once submitted by me and accepted by the institution. If third party approval for tuition funding is required, this agreement is not binding until such approval is granted.

I understand that electronically typing my name into this document is considered to be the same legally-binding effect as signing my signature using pen and paper.

High School Completion/Equivalent Self-Certification Form

Name:	Date of Birth:

Please choose the option that applies to you and fill in the information:

I certify that I have successfully graduated from high school with a standard diploma:

Date: Month and Year Name of High School City State

I certify I have successfully completed a High School Equivalent Program

Date: Month and Year City State

My signature below certifies that I have graduated or have received the equivalent of a high school diploma (for example, GED, accredited alternative diploma program, HiSET) by the start date of the program for which I am enrolling.

I understand that if I provide false information about graduation from high school or equivalent, I may be required to return any Title IV financial aid funds I receive. Falsification of records could also result in disciplinary action from the college, including dismissal.

I also understand that the college may require me to provide documentation of high school graduation or equivalency.

Signature:	Date:

Student Contract
Participation and Substantive Interaction Requirements

The purpose of this letter is to ensure that every student is fully aware of the requirements of their program.

The program you have chosen has very specific requirements for students’ participation and completion of coursework. These requirements are summarized below. Please review and sign, acknowledging your understanding of the time commitments which are required to satisfactorily complete your program. Congratulations and best of luck in your program!

You will receive a schedule which provides for specific time frames for completion of coursework.

While you can choose to complete your coursework on any particular day, or time of day, the coursework must be complete by the due dates provided in your schedule.

Typical weekly participation includes substantively interacting with fellow students and instructors in discussion and collaboration forums, regularly logging into your course(s), and submitting all coursework in a timely fashion.

It is important for you to know that if a student does not show evidence of pursuing their coursework by not submitting required assignments or participating in scheduled academic events for 21 consecutive days the student could be placed on academic progress and financial aid warning and probation or terminated.

If you feel you are having a challenge that would prohibit you from completing an assignment by the due date, you must contact your instructor 24 hours before the due date.

I understand that electronically typing my name into this document is considered to be the same legally-binding effect as signing my signature using pen and paper.

*Student Signature: *Date:

Equipment Return Policy

Martinsburg College provides a tablet, on loan, to the undersigned student, for use during his/her enrollment period. This is optional. If students do not require the use of a loaner tablet, they can inform the student services department. The student agrees to adhere to the following conditions:

* I understand that the tablet is to be used as a tool to assist me in my program. The uses of the tablet include: viewing electronic texts, conducting, etc. I understand that the tablet is not designed to replace the need for a computer in order to complete my program. Certain elements of the course content will not run on tablets and a computer is required.

* The tablet will be returned to Martinsburg College, unless purchased, at the time of graduation in good working condition. All accessories, including the power cord, must be returned with the tablet. If students choose to purchase the tablet, the purchase price for the tablet is $20. If students choose to return the tablet, upon graduation, they are responsible for the cost of return shipping.

* The student is responsible for damage to the tablet that occurs as a result of impact, liquid spillage, negligence, or other occurrences that are not covered under the manufacturer`s warranty. The warranty does not cover screens so any damage to the screen, including excessive scratches, is the student`s responsibility and repairs may incur additional charges. Please note, the tablet is for educational use by you only; it is not to be used by others.

* I understand and accept that the buyback option is available to graduate students only. If I withdraw from the program or cancel my enrollment, I am responsible for returning the tablet to Martinsburg College at the time of withdrawal/cancellation. I also understand that failure to do so will result in my being billed for the original cost of the tablet.

I,, have read and agree to abide by all provisions of the Equipment Return Policy listed above. I understand that electronically typing my name into this document is considered to be the same legally-binding effect as signing my signature using pen and paper.

Equipment Return Policy

* The following information is only for students enrolling in the Medical Office Administration program who do not possess a computer: One of the non-required elective courses available to students in this program contains some coursework/exercises that requires the use of a computer. I acknowledge that if I choose to take this elective course, I will need to have access to a computer in order to complete this course.

Materials Return Policy

Martinsburg College provides a textbook, on loan, to the undersigned student, for use during his/her enrollment period. This is optional. Students may choose to purchase the textbook rather than loan it. Students who do not require the use of a loaner textbook can inform the student services department. The student agrees to adhere to the following conditions:

* The textbook will be returned to Martinsburg College, unless purchased, after graduation. If students choose to purchase the textbook the purchase price is $35.00. If students choose to return the textbook, upon graduation, they will be provided with a pre-paid shipping envelope.

* I understand and accept that the buyback option is available to graduate students only. If I withdraw from the program or cancel my enrollment, I am responsible for returning the textbook to Martinsburg College at the time of withdrawal/cancellation. I also understand that failure to do so will result in my being billed for the original cost of the book.

I,, have read and agree to abide by all provisions of the Materials Return Policy listed above. I understand that electronically typing my name into this document is considered to be the same legally-binding effect as signing my signature using pen and paper.

Disclosures

By digitally signing below I am acknowledging that I have received, and reviewed, the following important Martinsburg College Policies.

* I have received and reviewed a copy of THE NOTICE OF FEDERAL STUDENT FINANCIAL AID PENALTIES FOR DRUG LAW VIOLATIONS and THE POLICIES AND STANDARDS RELATED TO THE PREVENTION OF THE ABUSE OF ALCOHOL AND OTHER SUBSTANCES. I understand that if I am a drug or alcohol offender, I will be dismissed from the school immediately. Possession, distribution, or use of alcohol or illicit substances may bring immediate expulsion.

I understand that electronically typing my name into this document is considered to be the same legally-binding effect as signing my signature using pen and paper.

*Signature: *Date:

* I have received and reviewed the NOTICE OF AVAILABILITY OF INSTITUTIONAL FINANCIAL AID INFORMATION.

I understand that electronically typing my name into this document is considered to be the same legally-binding effect as signing my signature using pen and paper.

*Signature: *Date:

Emergency Contact Information

*Name:
*Address:
*City:		* State:
* Country:		* Zip/Postal Code:
Home Tel.:		* Cell Tel.:
* Email Address:
* Relationship:

Employer information:

*Employer:
*Supervisor's Name:
*Supervisor's Phone Number:
*Supervisor's Email Address:

If you are currently deployed, please list your closest contact's information, (Spouse, Parents, Siblings):

Name:
Address:
City:	State:	Zip/Postal Code:
Home Tel.:	Cell Tel.:
Email Address:
Relationship:

* MC may contact any of the names listed to assist in providing communications to you, including the use of social media.