STUDENT’S NAME: __________________________________ DATE COMPLETING STUDIES: _____________
PARENT’S NAME: ____________________________________________________________________________
ADDRESS: __________________________________________________________________________________
TELEPHONE #: ________________ FAX #: ________________ E.MAIL: ________________________________
| REQUESTED SERVICES |
FEE QUOTE |
| Personal Consultation |
_________ |
| Assessment and Recommendations |
_________ |
| Application Assistance and Support Program |
_________ |
| Comprehensive College Planning Program |
_________ |
| Campus Visit Program |
_________ |
| Independent Secondary School Program |
_________ |
| Personal and Career Assessment Program |
_________ |
| Ongoing Support Program |
_________ |
| Quarterly Support Program |
_________ |
| Transfer Program |
_________ |
| English Language Program |
_________ |
| Summer Enrichment Program |
_________ |
| Special Needs Program |
_________ |
EXPENSES: All expenses including but not limited to telephone, telefax, postage, courier, hospitality, travel, etc., will be charged additionally.
DEPOSIT: A deposit of ________ for fees and expenses is requested at the time this Contact is signed and returned. You may remit payment via wire transfer to Fleet Bank, 94 Elm Street, New Canaan, CT. 06840. ABA #011.900571, to credit Educational Futures, account #94429 07049. To ensure proper credit when paying by bank transfer, please indicate your name on the transfer slip.
SIGNED: ______________________________ DATE: ________________________
Parent
SIGNED: ______________________________ DATE: ________________________
Educational Futures
PLEASE RETURN ONE COPY WITH YOUR DEPOSIT TO THE ABOVE ADDRESS
|
|