MedCertify Enrollment Agreement


Program Name & Tuition:  

Admission Representative:


Full Name:

Street Address:

City: State/Country:    

Phone Number:

E-Mail Address:

Social Security Number:

Emergency Contact Name:  

Emergency Contact Phone Number:  

Method of Payment:  

Total Program Cost:

Program Type: Certificate        Delivery Method: Online

Total Clock Hours:               Total Weeks:  

Textbook/eBooks Average                                    $ (estimated)
LMS Fee                                                                   $   (paid to school)
CPR, TB & Hep B                                                    $ cost varies (estimated)
National Exam                                                        $ cost varies (paid directly to them)
Online Technology Requirements                       $ cost varies (see catalog)


Please read this Enrollment Agreement thoroughly as you are agreeing to the following:


Scholarship Type: Institutional Scholarship

Scholarship Amount: $ 

By initialing below you are accepting the scholarship(s) awarded and understand any and all scholarships provided by MedCertify are based off of individual qualifications at the time of application and are between the recipient and said institution.


By initialing below you are acknowledging you have read the and understand this agreement and acknowledge receipt of a copy. You understand the awarded scholarship cannot be transferred to another institution or person and some may only apply to certain offered programs. You are also required to maintain full time enrollment and minimal academic standards per the student catalog. You understand that if you default upon this agreement, the awarded scholarship will be revoked and you will be responsible for any and all fees set by any and all financial lenders.



I, Undersigned, do hereby give my consent and agree the MedCertify employees have the right to take photographs, videotape, or digital recordings of me to use in any and all media outlets. I further consent that my name and identity may be revealed therein or by descriptive text or commentary. I understand there will be no financial or other forms of remuneration for any of the above, either for initial or subsequent transmission or playback. I represent I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.



MedCertify post-secondary educational establishments are NOT eligible for Title IV funding or Student Aid programs administered by the U.S. Department of Education. The federal government generally does not provide loans, grants or other forms of financial assistance to students attending a non-accredited college. (

According to the IRS, students can only deduct their loan interest if the loan was used at a school that participates in the U.S. student aid program. This is limited to schools with approved accreditation. Therefore, MedCertify schools are not eligible to provide tax Form 1098-T for tuition statement or Form 1098-E for student loan interest statement. Personal loans are utilized for educational purposes, and students are advised and must authorize this attestation in advance of attendance. 

Tax preparers will be supplied a W-9 Form upon request. MedCertify employees are not qualified to advise students on tax matters. 



MedCertify is committed to providing a safe and professional work environment for our students, volunteers, faculty and staff while on campus or at a clinical affiliation.

All students must be physically and mentally free of illegal drugs, alcohol, and prescription drugs that impair their intellectual and emotional functions. Some clinical affiliations (externships) require students to complete drug screening and/or a background check prior to clinical placement, or during if suspect of drug use. A positive drug screen may exclude you from clinical placement, graduation, and may warrant dismissal from the school.

Without exception, any student found in possession of these substances or a student is suspected of being under the influence of these substances (alcohol, illegal drugs, and prescription drugs) the Instructor and/or the Campus Supervisor will ask the student to leave the facility and immediately be drug tested at the student’s expense. Results are to be faxed directly to the instructor and must be received within 24 hours of being dismissed. The results will only be shared with the Instructor, Campus Supervisor and Education Director.

A positive test, failure or refusal to complete requested drug testing will result in automatic dismissal from the program. In the event of a positive test result, resources will be made available to the student to assist in counseling, treatment, or rehabilitation. Any student wishing to re-enroll after a positive drug screen or refusal to submit to testing must comply with an immediate drug screen upon admittance and is subject to random drug screening during their program at the student’s own expense. Any further positive test results or refusal will be cause for expulsion without option to re-enroll.



Students must adhere to conduct that will not interfere with the learning process of any other student, teacher,externship site, or the progress of the class in general. Those students whose conduct reflects discredit upon themselves or the school will be subject to immediate expulsion. The MedCertify reserves the right to exercise judgment of a student and to terminate a student for any of the following reasons:

  • Breach of the school enrollment agreement, Failure to abide by the rules and regulations of any clinical site, Entering externship site while under the influence of any type of, Alcohol or drugs , Possession of a dangerous or deadly weapon concealed or otherwise, Instigation, or participation in, rebellious activities against the school or its students, Solicitation which reflects unfavorably upon the school or its students, Failure to conform to the rules and regulations of the school, Conduct that reflects unfavorably upon the school or its students, Excessive absences or tardiness at campus or externship, Failure to pay charges when due, Cheating, Falsifying school records, Written or verbal profanity on campus/externship grounds, Vandalism of campus property, Disruptive classroom behavior, Physical threats of any nature, or Theft of any kind.

First Offense:
Behavior- The student is issued a written warning. A copy is kept in student’s file.
Academic- The student must redo or modify the assignment or exam at a 30% penalty, if student refuses to redo a zero will be earned.
Second Offense:
Behavior- The student must meet with the Program or Campus Supervisor to determine a course of action. A plan of action and/or incident report will be placed in student’s file.
Academic- The student will receive a zero on the item in question. No redo’s allowed.
Third Offense:
Behavior or Academic- The student will be expelled. Written documentation will be placed in student’s file.
When a student is determined to be guilty of academic or behavioral misconduct, the instructor will determine if a prior offense exists. Offenses accumulate during the students’ academic program(s). If prior incidents have occurred they will impact the current offense. Misconduct incidents may merit immediate expulsion and no warnings will be given, dependent on severity and outcome. MedCertify strive to graduate only the upmost professional medical and dental assistants.

By signing this agreement you agree to having read and fully understand the expectations as a student at MedCertify regarding misconduct.


Cancellation and Refund Policy:

Student must provide written notice of cancellation/withdrawal either by electronic submission to or by certified mail, to include: name, date, program enrolled, campus location and reason for cancellation to:

ATTN: Cassie Black, Operations Manager

2704 Old Rosebud Rd, Suite 130

Lexington, KY 40509

Program Cancellation: 

The school may cancel a program at its discretion. Should this occur, any students enrolled prior to cancellation, will be notified of this change and will have the option of applying all monies paid toward another program or receiving a refund of all tuition paid within 30 days of the cancellation date.


An applicant, who provides electronic submission or certified letter of cancellation after executing the enrollment agreement, but prior to the orientation of the program, is entitled to a full refund of all paid tuition. Unless they have been offered or secured employment in the field as a result of enrollment. Student has six months from enrollment date to seek any refunds of paid tuition. All refunds will be made within 30 days of the written notice receipt.

Withdrawal Procedure: 

  1. Students choosing to withdraw from a program after the orientation date are required to provide written notice of withdrawal as required above (attendance will be calculated until electronic submission or certified letter is received) and advised to discuss with the On-site Administrator to complete an exit interview.  The purpose of the exit interview is to assess the academic and financial status of the student. 

  2. has selected three consecutive scheduled class absences, without prior administrative approval, as the unofficial date which a student is deemed to have withdrawn. Students have six months from last attended date of class to request a refund of monies paid towards tuition. After this deadline, no refunds will be issued.

  3. For students seeking a refund of tuition: Refunds are based on the amount of tuition paid, fees not included in tuition are non-refundable. Administrative fee of $400 will be deducted from the refund amount. Students who received tuition credit should assume amount credited will be deducted from the refund amount. All refunds will be made within 30 days of the receipt of certified letter. Refunds will be calculated as follows: Orientation through Week 2- 75% refund, Week 3 through Week 4- 50% refund, Week 5 through Week 6- 25%, No refunds after Week 6. Students not eligible for refund will be offered the option to take a Leave of Absence (LOA) and return to complete the program within 6 months from withdrawal. 

  4. Students who have acquired or been offered employment in the field upon enrollment are not eligible for tuition refund. Students who receive a refund will not be eligible to receive any certificates as all courses in the program must be completed to receive a certificate of completion. Students who receive a refund are not eligible for any future institutional scholarships.


Grievance/Complaint Procedure:

The first step to resolve a complaint or issue is to discuss it with your instructor or other parties involved. If the issue is unresolved, after following the initial procedures, the issue isn’t resolved to your satisfaction; you may file a grievance as follows; all grievances must be made in electronic file format within seven days of the original grievance and submitted via email to the Grievance Committee at [email protected]  The grievance will be addressed within 30 days. recognizes the right of students to express their grievances. seeks to work together for a solution and to address those concerns. If all steps have been followed as stated and a resolution is not forthcoming, students may file a complaint with the Kentucky Commission on Proprietary Education. 


Upon execution of this agreement; the MedCertify catalog, which contains information describing programs offered, will be electronically delivered to you on the date of this agreement. The date executed is .

Filing a Complaint with the Kentucky Commission on Proprietary Education

To file a complaint with the Kentucky Commission on Proprietary Education, a complaint shall be in writing and shall be filed on Form PE-24, Form to File a Complaint, accompanied, if applicable, by Form PE-25, Authorization for Release of Student Records.

The form must be mailed to the following address:

Kentucky Commission on Proprietary Education

500 Mero Street, 4th Floor

Frankfort, Kentucky 40601

The form can be found at


KRS 165A.450 requires each school licensed by the Kentucky Commission on Proprietary to contribute to a Student Protection Fund which will be used to pay off debt incurred due to the closing of a school, discontinuance of a program, loss of license, or loss of accreditation by a school or program.


To file a claim against the Student Protection Fund, each person filing must submit a completed "Form for Claims Against the Student Protection Fund". This form can be found on the website at


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Signature Certificate
Document name: Enrollment Agreement
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February 8, 2022 3:46 PM EDTEnrollment Agreement Uploaded by MedCertify Education - [email protected] IP
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