I, , hereby request to withdraw from my ProgramEntry Level Dental AssistantPhlebotomy/EKG Technician course at IMDT - Fort Myers - 5280 Summerlin Commons Way #804 Fort Myers, FL 33907. By signing this document, I am agreeing that I have read and confirm the Cancellation & Refund Policy below that was also in my Enrollment Agreement & School Catalog.

Cancellation and Refund Policy:

Student must provide written notice of cancellation/withdrawal either by electronic submission to http://imdtfl.com/withdraw-request/ 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 45 days of the cancellation date.

Cancellation: 

An applicant, who provides electronic submission or certified letter of cancellation after executing the enrollment agreement, but prior to the digital 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. Students have six months from enrollment date to seek any refunds of paid tuition. All refunds will be made within 45 days of the written notice receipt.

Withdrawal Procedure: 

1. Students choosing to withdraw from a program after the digital 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 meet 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. The Medical Institute of Kentucky, Choice MD and IDT 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class absences, without prior administrative approval, as the unofficial date which a student is deemed to have withdrawn.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 the 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 $200 will be deducted from the refund amount. Students who received tuition credit should assume the amount credited will be deducted from the refund amount. All refunds will be made within 45 days of the receipt of the certified letter or electronic submission. Refunds will be calculated as follows: Digital 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 date. 
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.

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

Change fonts

• Draw Signature
  
• Type In Signature
  

Draw your signature with your mouse, tablet or smartphone Clear

I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

Insert Signature

I agree that I am and I understand this is a legal representation of my signature

Adopt & Sign

Signature Certificate

Document name: Withdraw Request

Unique Document ID: a0489874d02c431e348cf1883a599e12ae9fae46

Build. Track. Sign Contracts.

Timestamp	Audit
August 19, 2022 2:13 pm GMT	Withdraw Request Uploaded by Greg Goins - [email protected] IP 99.190.9.234
August 19, 2022 2:14 pm GMT	IMDT Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234
September 22, 2022 12:52 pm GMT	IMDT Documents - [email protected] added by Greg Goins - [email protected] as a CC'd Recipient Ip: 99.190.9.234

This audit trail report provides a detailed record of the online activity and events recorded for this document.

http://imdtfl.com/

Audit Trail Serial# 429b6708aa46c8c68879a69cf092b72c