Enrollment Application Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneEmail* Last Four Digits of SSNGenderMaleFemaleDate of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920I understand that the enrollment agreement is subject to acceptance by AHS-Genesis. I understand I am required to meet all the graduation requirements that are in place from the time I register in the program. Specific program requirements can be found in the Student Handbook and Catalog.Degree ProgramsPlease select the degree program(s) you wish to enroll in: Religious/Judaic Studies Associate Religious/Judaic Studies Bachelor My Example Program Fees: Course fees are calculated based on the number of units a course is worth. The current course fee for the 2016-2017 academic year is set at $50 per unit. Therefore, a three-unit course would result in a $150 fee. The total estimated program cost depends on the student’s program plan. The cost can be estimated by multiplying the total number of units by $50. For example, 15 units would cost $750, 30 units would cost $1500, and 90 units would cost $4500. Course fees are due prior to the sitting for each course final exam. Students are responsible to obtain any required textbooks necessary to complete their courses. Textbook costs are estimated at $25 - $125 per course. An advisor can help the student estimate the textbook costs for specific courses. Withdrawal: If you were charged traditional tuition, you may cancel your enrollment in any manner within 10 days of your receipt of the course materials and receive a complete refund. If you, for any reason, decide to discontinue your enrollment after that period the following settlement policy will apply (minus a registration fee of $75): Length of Course Portion of Refundable Tuition (minus registration fee) Due after 8 weeks 1st week=80% 2nd week=60% 3rd week=40% 4th week=20% 5th week=0% 9-16 weeks 1st week=80% 2nd week=70% 3rd week=60% 4th week=50% 5th week=40% 6th week=30% 7th week=20% 8th week=10% 9th week=0% Code of Conduct: As a student of AHS - Genesis, I recognize that in the pursuit of my educational goals and aspirations I have certain responsibilities toward my fellow learners, my institution, and myself. To fulfill these responsibilities, I pledge adherence to this Code of Conduct as found in the Student Handbook or Catalog. Plagiarism: While you are encouraged to study the course material in pairs, either with another enrolled student or a friend, care must be taken not to plagiarize another’s work. All work (assignments and examinations) is expected to be the result of your own efforts unless properly acknowledged to be the work of someone else. Violation of this policy can result in a failing grade for the course, which will become part of your official record. It is your responsibility to abstain from cheating and to guard against making it possible for others to cheat. Transfer Credit Policies: Typically credit earned within the last 20 years is considered for transfer. The consideration of credit earned more than 20 years ago will be determined on a case by case basis. Transfer credit is granted only for courses for which a grade equivalent to a “C-” or better has been earned. Courses in which a grade of “pass” is received must be certified by the school as being equivalent to a “C-” or higher in order to be accepted in transfer. Transfer credit will not be evaluated or denied solely on the source of accreditation of the sending institution. Transcripts from non US based institutions may require a foreign credential evaluation through World Education Services (wes.org). Up to 30 credits may be transferred from non-transcript sources of college credits. This includes credit be examination sources such as the CLEP or AP exam and credits for Prior Learning Assessment. Acceptance of credits from AHS-Genesis is up to the receiving institution. A student who anticipates transferring to another institution should first contact the other institution to determine whether or not their credit hours will transfer. Policies governing the transfer of credit vary greatly from school to school. Time Allowance: AHS – Genesis courses are generally designed to be completed over a semester. Students enrolling an Associate level program have up to three (3) years to earn their degree. Students enrolling in a Bachelor level program have up to six (6) years to earn their degree. Grievance Procedure: If, for any reasons, a student has a complaint, grievance, or dispute with AHS-Genesis, the student has the right to seek a satisfactory resolution through the following process: 1) Notification – The student must submit a written letter postmarked no later than 15 days after the occurrence to: Registrar, AHS-Genesis, 4000 Alton Road, Miami Beach, FL 33140. The letter must state the basis for the complaint, grievance, or dispute, provide details of the matter, and describe the requested remedy. The Registrar shall respond with a decision in writing within 15 days of receipt of the written letter. 2) Appeal – If the requested remedy is denied, the student may appeal in writing via mail within an additional 15 day period to: CAO, AHS-Genesis, 4000 Alton Road, Miami Beach, FL 33140. Failure to submit an appeal letter within the additional 15 day period will indicate that the student has accepted the initial decision as final and the matter shall be closed. Upon submission of the appeal letter, the CAO shall review the grievance and render a decision within 15 days of receipt of the appeal. The decision of the CAO shall be final. While students are encouraged to contact AHS-Genesis with questions or concerns, students who are dissatisfied with any action or decision of the institution may also elect to contact: Commission for Independent Education 325 W. Gaines Street, Suite 1414 Tallahassee, FL. 32399-0400 Distance Education Accrediting Commission1101 17th Street NW, Suite 808Washington, D.C. 20036202.234.5100 High School & City, StateHigh School Graduation YearHigh School Attestation- SignatureI understand that one of the requirements for admission to AHS – Genesis is a high school diploma or its equivalent. I certify that the high school graduation information provided is true and accurate. I understand that I may be required to submit a copy of my diploma or an official transcripts upon request. Please type name.What is the highest level of education you have attainedHigh School Diploma or EquivalentSome CollegeAssociates DegreeBachelors DegreeMasters DegreeDoctorate DegreeHave you previously attended postsecondary school:YesNoWhat type of postsecondary school have you attended (if any):None2-year College/Community College4-year College/UniversityCareer/Technical SchoolSeminary/Theological SchoolFilesIf you wish, you can upload copies of your transcripts here.List the colleges attended:I understand and agree that this Agreement is executed at the time of my enrollment at AHS-Genesis and that my enrollment in subsequent terms shall constitute a renewal of the terms of this Agreement, except exam and other fees may be revised. By signing this Agreement, I acknowledge that I have read this Agreement, received my copy of the Agreement and will abide by its terms. I further agree that I will abide by the institutional rules and regulations of AHS –Genesis as described in the Student Handbook and Catalog. I agree to comply with all AHS academic and financial regulations.Signature:*I understand electronically typing my name in this document is considered to have the same legally-binding effect as signing my signature using pen and paper.If under 18: Parent Signature:If student is under 18 a parent or legal guardian must sign. I understand electronically typing my name in this document is considered to have the same legally-binding effect as signing my signature using pen and paper.