Application - Enzweiler Building Institute

Full Legal Name*

First Middle Last Suffix

Date*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Social Security Number*

Date of Birth*

Mobile Number*

Home Phone Number

High School Attended*

Graduation or GED Date*

Emergency Contact*

Emergency Contact Phone*

Employer

Employer Phone

I am requesting admission to the following program as a new, first-time student:*

One-Time Registration Fee, Due with New-Student Application Form: $50.00 (non-refundable). You must submit the registration fee or your application will be voided.*

I understand that by submitting this form and the non-refundable registration payment of $50.00, I am requesting registration in my selected program of study. I understand that I will be admitted to the Enzweiler Building Institute (“EBI”) for the 2024-25 school year without further correspondence from the school.

I understand that the registration fee is non-refundable in all circumstances and is due with this registration form. (Only incoming, first-year students pay the registration fee. Continuing students do not.)*

I understand that New Student Orientation is mandatory, and I am required to attend.*

Consent*

I understand that tuition and fees are due on or before the first day of the 2024-25 Academic Year, September 3, 2024.*

I understand if I do not make full payment of tuition and fees on or before September 3, 2024, I will automatically be enrolled in the payment plan option at a cost to me of $100.*

I understand all tuition and fees must be paid in full by the end of the first semester (December 3, 2024) or I am subject to dismissal from the program. Should I be dismissed, my account will automatically be turned over to a collection agency.*

I have read and understand the Withdraw and Refund Policy:*

I understand ALL CANCELLATIONS MUST BE IN WRITING. ONLY A WRITTEN LETTER OR EMAIL TO THE DIRECTOR OF WORKFORCE DEVELOPMENT IS AN ACCEPTABLE FORM OF CANCELLATION. No other form of cancellation will be accepted. Cancellations are only accepted when received prior to September 3, 2024 (the first day of the academic year).

I understand that I will receive a 100% refund of all tuition and fees assessed, less book fees, if I cancel in writing prior to the first day of the academic year (September 3, 2024).*

I understand that if I elect to discontinue the training program in writing after the first night of class but prior to the second night of class, I shall receive a 50% refund of all tuition assessed, less book fees and a $100 termination fee.*

I understand if I elect to discontinue the training program in writing within 24 hours of the second night of class, I shall receive a 25% refund of all tuition assessed, less book fees and a $100 termination fee.*

I understand that after the second night of class, I will not receive any refund of any kind and will be assessed full tuition and fees for the academic year.*

I understand that classes and curriculum are subject to change to reflect the best interest of the class and industry trends. Curriculum or instructor changes will not result in a refund.*

A copy of this completed registration form shall be made available to me at any time upon request.*

For Students in the Electric Program ONLY:*

I understand that the Electric Program requires four years of attendance at EBI. I understand that successful completion of a provisional Kentucky license after my second year of schooling does not constitute completion of the program. I understand I am required to complete all four years of schooling or my license will be revoked by the Commonwealth of Kentucky.

Student Full Legal Name*

First Middle Last Suffix

Date

Electronic Signature Agreement*

I accept.

Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a keypad, mouse, or other device to select an item, button, icon, or similar act/action, or to otherwise provide (“EBI”) or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature and that the lack of such certification or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and (“EBI”) You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement. You further agree that each use of your E-Signature in obtaining a (“EBI”) OnLine service constitutes your agreement to be bound by the terms and conditions of the (“EBI”)

NEW Student Application and Contract

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