North Texas Healthcare AcademyEnrollment Application
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Student Enrollment Application

Complete all sections below. Type or print clearly and fill in every applicable field; enter "NA" where an item does not apply. You will sign electronically at the end and may upload supporting documents.

North Texas Healthcare Academy  ·  4222 Moulton St., Suite C, Greenville, TX 75401  ·  (945) 275-2352
TWC School No. S63704  ·  nthealthcareacademy.com
1. Student Application

In case of emergency, please notify

2. Student Enrollment Agreement

Program details and costs are confirmed by the school for your selected program and provided in the school catalog.

Payments will be made before the start of the first day of class.

"Any holder of this consumer credit contract is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed the amount paid by the debtor hereunder."

North Texas Healthcare Academy will give equal opportunity to all applicants regardless of race, sex, or national origin. Approved and regulated by the Texas Workforce Commission, Career Schools and Colleges. I have received a copy of this enrollment agreement and the catalog.

3. Cancellation & Refund Policy

Cancellation Policy

A full refund will be made to any student who cancels the enrollment contract within 72 hours (until midnight of the third day excluding Saturdays, Sundays and legal holidays) after the enrollment contract is signed. A full refund will also be made to any student who cancels enrollment within the student's first three scheduled class days, except that the school may retain not more than $100 in any administrative fees charged, as well as items of extra expense that are necessary for the portion of the program attended and stated separately on the enrollment agreement.

Refund Policy

  1. Refund computations will be based on scheduled course time of class attendance through the last date of attendance. Leaves of absence, suspensions and school holidays will not be counted as part of the scheduled class attendance.
  2. The effective date of termination for refund purposes will be the earliest of the following: (a) the last day of attendance, if the student is terminated by the school; (b) the date of receipt of written notice from the student; or (c) ten school days following the last date of attendance.
  3. If tuition and fees are collected in advance of entrance, and if after expiration of the 72 hour cancellation privilege the student does not enter school, not more than $100 in any administrative fees charged shall be retained by the school for the entire residence program or synchronous distance education course.
  4. If a student enters a residence or synchronous distance education program and withdraws or is otherwise terminated after the cancellation period, the school or college may retain not more than $100 in any administrative fees charged for the entire program. The minimum refund of the remaining tuition and fees will be the pro rata portion of tuition, fees, and other charges that the number of hours remaining in the portion of the course or program for which the student has been charged after the effective date of termination bears to the total number of hours in the portion of the course or program for which the student has been charged, except that a student may not collect a refund if the student has completed 75 percent or more of the total number of hours in the portion of the program for which the student has been charged on the effective date of termination.
  5. Refunds for items of extra expense to the student, such as books, tools, or other supplies are to be handled separately from refund of tuition and other academic fees.
  6. A student who withdraws for a reason unrelated to the student's academic status after the 75 percent completion mark and requests a grade at the time of withdrawal shall be given a grade of "incomplete" and permitted to re-enroll in the course or program during the 12-month period following the date the student withdrew without payment of additional tuition for that portion of the course or program.
  7. A full refund of all tuition and fees is due and refundable in each of the following cases: (a) an enrollee is not accepted by the school; (b) if the course of instruction is discontinued by the school and this prevents the student from completing the course; or (c) if the student's enrollment was procured as a result of any misrepresentation in advertising, promotional materials of the school, or representations by the owner or representatives of the school.
  8. Refund policy for students called to active military service: a student who withdraws as a result of being called to active duty in a military service of the United States or the Texas National Guard may elect one of the options described in the school catalog (pro rata refund, a grade of incomplete with the designation "withdrawn-military," or, where at least 90 percent of coursework is completed, an appropriate final grade or credit).
  9. The payment of refunds will be totally completed such that the refund instrument has been negotiated or credited into the proper account(s), within 60 days after the effective date of termination.
4. Receipt of Enrollment Policies

Texas Workforce Commission — Career Schools and Colleges (Form CSC-009). Check each item to acknowledge receipt prior to enrollment.

A. I have received prior to enrollment:

B. Transferability of Credit Hours

C. Other Acknowledgments

5. Acknowledgments — Please Initial

Enter your initials on each line to acknowledge.

I have had the opportunity to tour the school facilities and equipment.
I have been furnished with the school catalog. It is my responsibility to read and abide by the policies in the catalog.
The passing grade for this course is 70%. Students with an overall average, skills lab, or final exam grade below the passing grade will not be allowed to continue the clinical portion of the class.
I give permission to North Texas Healthcare Academy to release my grades, attendance, and progress reports to any agency/organization assisting me financially. I also give permission for my name and photograph to be used for graduation announcements and course promotion materials.
6. Record of Previous Education & Training

Texas Workforce Commission — Career Schools and Colleges (Form CSC-010). Enter "NA" where not applicable.

Name & location of schoolDates attendedGraduated?Diploma / field of study
7. Supporting Documents (optional)

Upload a photo ID, high school diploma/GED, or any documents requested by the school. Accepted: PDF, JPG, PNG.

8. Electronic Signature

Sign in the box below using your mouse or finger. This applies to the Enrollment Agreement and all acknowledgments above.

Draw your signature above.

By submitting, a copy of your application is sent to North Texas Healthcare Academy. The school will contact you to complete enrollment and payment.