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            Enrollment Deposit   ($ 100.00)

            Please list the student name and contact information below. Your Student ID is required in order to submit the enrollment deposit. If you do not know your Student ID number or if you need any assistance with this form, please contact the Office of Admissions at 1-800-648-1463.

            Student Information

            Enter a name.
            Enter a valid ID number.
            Enter a valid email address.
            Enter a phone number.
            Enter a street address.
            Select a city.
            Select a state.
            Enter a valid zip code.
            Select a student type.
            Select a student term.

            Card Holder Information

            Enter a name.
            Enter a valid street address.
            Enter a valid city.
            Select a state.
            Enter a valid zip code.

            Credit Card Information

            Enter a valid credit card number.
            Enter a valid CSC code.
            Select an expiration month.
            Select a expiration year.

            Note: There will probably be a short delay during processing of the payment. Do not click the submit button twice, or duplicate charges may result.

            Enrollment deposits are refundable up until May 1. After May 1, all enrollment deposits are non-refundable.