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Get File Group Id 63286 (California Maritime Academy)

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Department of Sponsored Projects and Extended Learning
(707) 654-1157 ■ Fax (707) 654-1158
200 Maritime Academy Drive, Vallejo, CA 94590
Email: xl@csum.edu ■ Website: www.csum.edu or www.maritime-education.com
Course Enrollment Form
Name:
Date:
Address:
SSN# :
City:
ST:
ZIP:
Phone:
Alt:
Company:
Email:
CMA Graduate/Year:______
Ver.
DATE
TIME
COST
$
$
$
$
SUBTOTAL:
$
DISCOUNT (If applicable):
$
DATE PAID:____________________
AMT OF DEPOSIT:
$
DATE FINANCIAL AID EXPECTED:____________________
AMOUNT REC’D:
$
EMAILED RECEIPT DATE PAID:____________________
BALANCE
DUE /
TOTAL:
$
How did you hear about our program? Website/Search Engine/Social Media/Online Ad Company
Friend/Family/Student Print Ad/Article/Newsletter E-Mail
Please identify source of referral :_____________________________________________________________________
(Required texts will be the responsibility of the student. Please consult course requirements.)
Course fees may be paid by cash, check (payable to CMA ), purchase orders or with American Express, Visa or MasterCard credit card.
50% deposit registers and reserves your seat in the class.
All registration must be paid in full.(2) two calendar weeks prior to the
beginning of the class. There will be a $25.00
fee charged for all returned checks. Extended Learning will provide a full refund if a
student cancels 15 or more calendar days before the start of the class. Cancellations received between 14 and 7 days before t
he start of
the class will be charged a fee
of 25% of the class tuition. Cancellations received less than one week prior to the start of the class will
receive a 50% refund of class tuition. Cancellations received one day prior to or at the start of the class will receive no
refund. Students
who are registered yet fail to attend, as well as those who do not complete the program, will not be eligible for refunds.
ADA Statement
The California Maritime Academy, Department of Sponsored Projects and Extended Learning is committed to providing reasonable
accommodations for students with disabilities upon request of the student (in a timely fashion) and upon verification of disa
bility. For more
information, please call (707)654-1157.
Please check one:
Cash Check Visa/Mastercard American Express
Name:
Amt:
Card #:
Exp Date:
Signature:
The Department of Sponsored Projects and Extended Learning reserves the right to cancel classes.
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Completed 16 July 2020

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