SHCOHS Enrollment Form SHCOHS Student Payment Information "*" indicates required fields Step 1 of 4 25% Enrolling Student InformationPlease provide the following information for the enrolling student.Name* First Middle Last Suffix Preferred Name Previous Last Name Email* Primary Phone*Best Time to ContactEarly Morning (7 am to 9 am)Morning (9 am to Noon)Afternoon (Noon to 4 pm)Early Evening (4 pm to 8 pm)Late Evening (After 8 pm)Checking this box constitutes your express written consent to be called and/or texted by Smart Horizons Career Online High School (SHCOHS) at the phone number provided and you understand that these calls may be generated using automated technology.* I agreeAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Demographic InformationDate of Birth* Month Day Year Gender*SelectFemaleMaleNon-BinaryXPrefer not to answerWhat is the last grade level you completed?*Select6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeAre you currently employed?*SelectPart-TimeFull-TimeNoRacial/Ethnic BackgroundSchool districts are asked by many, including the federal government and accrediting associations to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to answer the following two questions: Do you consider yourself to be Hispanic/Latino?*SelectYesNoIn addition, please select one or more of the following racial categories to describe yourself:* American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Prefer not to answer Alternative & Emergency Contact InformationIt is the responsibility of the student to update SHCOHS with new emergency contact information, as needed, throughout their enrollment.Alternative Contact Name* First Last Alternative Contact Phone*Alternative Contact Relationship* I give permission to SHCOHS to contact this person, in the event of an emergency.* I consentStudent Enrollment Information Privacy & SharingStudents above the age of 18 must consent to sharing information with other people or organizations, including parents and spouses. If you wish to provide permission to SHCOHS to discuss enrollment and progress information you must consent below.Express written consent and permission that SHCOHS may provide enrollment and progress information with the following individual.SelectI consent that the below named person may receive enrollment and progress information.I do not consent to SHCOHS sharing my information with any individuals or non-essential organizationsName First Last Relationship to Student Today's Date Month Day Year Enrollment InformationCareer Certification Selection*SelectChildcare & EducationIntroduction to Commercial DrivingFood & Customer Service SkillsGeneral Career PreparationHome Care ProfessionalHospitality & LeisureIntroduction to ManufacturingOffice ManagementRetail Customer ServiceSecurity ProfessionalYou can review the career certificate courses here: https://smarthorizonsonline.org/career-certificates/All students will be required to provide photo identification. If you wish, you can upload a scanned copy or a picture of it at this time.Max. file size: 50 MB.Enrollment Agreement*STUDENT ENROLLMENT AGREEMENT This Student Enrollment Agreement (which is referred to herein as the “Agreement”), is a binding agreement between you (the “Student”) and Smart Horizons Career Online High School (which is referred to as either the “School” or “Smart Horizons Career Online High School”). This Agreement is to be read in conjunction with the School’s Student Handbook, which shall also govern the Student’s relationship with the School. The Agreement shall become binding and effective upon the School’s acceptance hereof. The Student and the School hereby agree as follows: 1. ADMISSIONS CRITERIA: All students entering Smart Horizons Career Online High School must be at least sixteen (16) years of age prior to the first day of class and have successfully completed the 8th Grade at an accredited institution. Minors will be required to obtain parental or guardian consent to enroll and parents or guardians will be required to indicate their responsibility for the minor’s financial obligations hereunder. For minors enrolled in the School, references to the Student’s financial responsibility below shall apply to the parent or guardian of the minor. 2. NON-DISCRIMINATORY CLAUSE: Smart Horizons Career Online High School will never deny admissions to anyone on the basis of race, color, creed, sex, or national origin. 3. FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT (FERPA): FERPA provides students who are 18 years of age or older certain rights with respect to their educational records. One of those rights is to deny others access to their educational records. This right remains in effect until a student provides written consent to disclose information in their educational records to others. As a result of FERPA, the Student understands that if the Student desires any school official to discuss Student’s progress with someone other than Student, the Student must first provide written consent. 4. TUITION: The tuition amount is fourteen hundred ninety-five dollars ($1495), which includes a $35 non-refundable Enrollment Application Fee. The School offers two (2) different tuition payment options: Option 1: Full Payment Plan and Option 2: Automatic Monthly Payment Plan. The details of the two options are as follows: Option 1: Full Payment Plan. Under this plan, the Student pays the entire tuition amount of $1495 upon enrollment. The Student’s enrollment in the School will not be effective until the School receives full payment of the tuition amount. Payment is to be made in U.S. dollars. Option 2: Auto-Payment Plan. Under this plan, the Student pays the entire tuition amount of $1,495 plus a thirty-five dollar ($35) payment plan administrative fee. The total amount due, including tuition and payment plan administrative fee, is fifteenhundred thirty dollars ($1530). The amount of $1530 shall be paid in eighteen (18) equal monthly installments of seventy-seven dollars ($85) each. The Student’s enrollment in the School will not be effective until the School receives the first monthly tuition payment of $85. The second monthly payment of $85 shall be due thirty (30) days thereafter, and all remaining payments will be due on that same day each month thereafter. Payments are to be made in U.S. dollars. The Student is required to provide a credit or debit card to make monthly payments. The Student shall give the School the relevant credit or debit card information, and the Student is responsible for updating such credit or debit card information should the card expire or is otherwise no longer able to be used to make payments or the Student desires to use another credit or debit card to avoid any payment issues. OPTION 2 LATE PAYMENT POLICY: The Student is responsible for the Student’s monthly payment obligations, and these payments must be received in full by the due date. If the Student fails to make payment within ten (10) days after the scheduled payment date, the Student will be notified of the overdue payment and the Student’s account will be suspended. Student’s access to the student portal will be restricted until the overdue payment is received by the School. SUSPENDED ACCESS POLICY: If Student fails to make payment to reactivate access to the program within ninety (90) days of Student’s suspension date, Student will be automatically withdrawn from the program. If Student is automatically withdrawn and desires to complete the program, Student will need to contact the School to discuss options. 5. REFUND POLICY: The Student has 5 business days from the enrollment date to cancel their enrollment and only be responsible for the $35 non-refundable Enrollment Application Fee. Students that pay their tuition in full upon enrollment will receive a refund in the amount of $1,460 if they cancel their enrollment within the 5 business days. Students who select to pay their tuition in monthly payments will have no further financial obligation after paying the $35 non-refundable Enrollment Application Fee if they cancel their enrollment within the 5 business days. After 5 business days from the date of enrollment has passed, a refund is no longer available and the Student is obligated to pay the full tuition amount even after the Student requests to cancel their enrollment. Students that select to pay their tuition in monthly payments are obligated and agree to continue to make the monthly payments of $85 until the entire tuition amount of $1530 has been paid. 6. WITHDRAWAL POLICY: To cancel your enrollment, please contact the Enrollment Office at 866.999.7853 or email enrollment@shcoe.org. Although your enrollment may be canceled either orally or in writing, we recommend that you provide a written notice of your request to cancel. All cancellations are subject to the School’s refund policy. 7. SMART HORIZONS CAREER ONLINE HIGH SCHOOL PROGRAM: While the School’s program is detailed more fully in the Student Handbook, in general, the Smart Horizons Career Online High School Program, includes eighteen (18) months of access and the following: · 18 Online High School Courses · High School Diploma · High School Transcript · Certificate in Career Major 8. GRADUATION REQUIREMENTS: In order to graduate from the School and to receive a diploma, certificate in career major, and high school transcript, the Student, must successfully complete all graduation requirements as specified in the Student Handbook, pass all assignments with a seventy (70%) percent average, and satisfy all financial obligations to the School. Neither a diploma or certificate will be issued, nor transcripts released, until all tuition amounts are collected in full. 9. GROUNDS FOR TERMINATION: Student’s enrollment may be terminated for several reasons, including Student’s failure to comply with the School’s rules and policies, failure to comply with the terms and conditions set forth herein and in the Student Handbook, or the failure to make scheduled payments when due. The School may terminate Student’s enrollment at any time for such violations. The School further reserves the right to modify the rules and policies in the Student Handbook, and any such revisions will be posted online at www.smarthorizonsonline.org. 10. ACCREDITATION: Student understands that Smart Horizons Career Online High School is a division within the Smart Horizons Career Online Education District, an Cognia/SACS fully accredited school district. 11. NO GUARANTEE: YOU UNDERSTAND AND AGREE THAT COMPLETION OF THE SMART HORIZONS CAREER ONLINE HIGH SCHOOL, AND OBTAINING A DIPLOMA AND CAREER MAJOR CERTIFICATE IS NOT A GUARANTEE OF EMPLOYMENT OR ADMISSION TO A FOUR-YEAR COLLEGE, COMMUNITY COLLEGE AND/OR A CAREER COLLEGE. SMART HORIZONS CAREER ONLINE HIGH SCHOOL HAS NOT MADE ANY PROMISE TO YOU, EXPRESS OR IMPLIED, REGARDING ANY OPPORTUNITIES FOR YOU FOLLOWING COMPLETION OF THE SCHOOL. YOU, THE STUDENT, UNDERSTAND THAT EACH FOUR-YEAR COLLEGE, COMMUNITY COLLEGE AND/OR CAREER COLLEGE HAS ITS OWN MINIMUM ADMISSION STANDARDS, AND THE DIPLOMA AND CAREER MAJOR CERTIFICATE MAY OR MAY NOT BE ACCEPTED AS MEETING THE MINIMUM ADMISSION STANDARDS. YOU, THE STUDENT, AGREE TO RELEASE, INDEMNIFY, DEFEND AND HOLD HARMLESS SMART HORIZONS CAREER ONLINE HIGH SCHOOL, ITS OFFICERS, DIRECTORS, EMPLOYEES, AND AGENTS FROM ANY SUCH CLAIM. IN ADDITION, YOU, THE STUDENT, SHOULD CHECK WITH YOUR STATE AND THE POST SECONDARY INSTITUTE OF YOUR CHOICE TO UNDERSTAND THE REQUIREMENTS FOR OBTAINING FINANCIAL ASSISTANCE. STATES HAVE CERTAIN FINANCIAL AID REQUIREMENTS FOR POST SECONDARY EDUCATION THAT MAY RESULT IN INSTITUTIONS NOT RECOGNIZING YOUR ONLINE HIGH SCHOOL DIPLOMA. IT IS RECOMMENDED THAT YOU, THE STUDENT, CHECK WITH YOUR SELECTED INSTITUTION TO OBTAIN A BETTER UNDERSTANDING OF THE REQUIREMENTS AND ANY POTENTIAL RESTRICTIONS RELATING TO YOUR ONLINE HIGH SCHOOL DIPLOMA, PARTICULARLY FOR STUDENTS RESIDING IN THE STATE OF NEW YORK. 12. JURISDICTION FOR DISPUTES: Any suit, action or proceeding arising out of or relating to, and/or to enforce, this Agreement may be commenced and maintained only in a Florida state court of competent subject matter jurisdiction in Escambia County, Florida, and each Party waives objection to such jurisdiction and venue. The Parties expressly, knowingly and voluntarily waive any right to a trial by jury in any proceeding arising out of or relating to, and/or to enforce, this Agreement. This Agreement shall be construed and enforced in accordance with the laws of the State of Florida, without regard to its conflict of law provisions. I agree to the terms of the Student Enrollment AgreementSelect Payment Option* Full Tuition Payment: $1,495.00 (Pay $1,495 upon enrollment. $35 registration fee waived) Payment Plan: $1,530.00 (Pay $85 upon enrollment, then 17 automatic monthly payments of $85 will be charged to your credit/debit card.) Please choose from one of the payment options.Credit Card Cardholder Name Card Details