Golden Gate School of Feng Shui Application and Registration 2010-2011! Today s Date Legal Name AKA Name(s) Address City State Zip Home Phone Mobile Work Phone Email Date of Birth Place of Birth Country of Citizenship Current Occupation Gender: Male Female What is your native language? English Other How did you hear about GGSFS? Personal Statement This section must be completed and returned to Golden Gate School of Feng Shui (GGSFS) within 5 days of the date of this application. Personal statements can be emailed to info@fengshuischool.com We are excited to get to know you better. Please address all of the following questions on one to three type - written pages.! Tell us about yourself! Please write a brief statement about your life and what led you to apply to GGSFS. Include significant life events such as personal, educational, and professional experiences, as well as specific interests.! Describe your experience with feng shui (if applicable).! GGSFS combines community-based learning with intensive self-discovery and academics. Describe your experience, strengths and challenges in the areas of community-learning and self-study discipline.! Describe your personal and professional goals and how you intend to utilize your feng shui training.! Please discuss your commitment to completing homework assignments. In order to be certified by GGSFS students are required to complete at least 12 hours of homework assignments between each class, half of which must be turned in within two weeks of class.! This program requires a keen listening ability and attention to detail. Following directions and completing assignments as well as taking responsibility for your participation in the program is part of ones path to embracing this body of knowledge. Please discuss where you see yourself in these areas, what you are still working on and your commitment to taking responsibility for your learning experience.
Educational History (This section is for our information only and will have no bearing on your application being accepted.) Please list all RELATED training, classes, programs, courses or workshops attended with the most recent first. Dates Name of Institution City/State Major/Focus Attended Qualification Earned (if any) Professional Licenses or Certifications License Type Issuing Agency Date Issued Expiration Date Emergency Contacts (Please list two) Name Address Phone Relationship International Applicants Only What type of Visa do you hold? Are you able to demonstrate English language proficiency at a level appropriate to Higher Education study? Yes No
Financial Information DISCOUNTS (select all that apply) EARLY REGISTRATION o Save $500 If you register by October 30th o Save $400 If you register by November 23rd o Save $300 If you register by December 3rd PAY IN FULL o Save $600 If you pay in full when accepted into the program TRAVELING DISCOUNTS (distances are each way and must be primary residence) o Save $100 If you travel more than 35 miles o Save $200 If you travel more than 75 miles o Save $300 If you travel more than 150 miles o Save $400 If you travel more than 300 miles o Save $600 If you travel more than 600 miles o Save $1000 If you travel more than 900 miles o Save $1600 If you travel more than 2500 miles AGE OR STUDENT DISCOUNTS (select one only) o Save $300 If you are 27 years old or under o Save $500 If you are 24 years old or under o Save $750 If you are 21 years old or under o Save $500 If you are 60 years old or above o Save $750 If you are 65 years old or above OR o Save $1000 If you are currently a full time student with a valid student ID card SINGLE PARENT DISCOUNT o Save $500 If you are a single parent (with a minor) FRIENDS AND FAMILY DISCOUNTS o Save $600 If you enroll with a friend ($300 each) o Save $2000 If you enroll with a spouse or an immediate family member ($1000 each) TUITION Full Tuition $ 8,995. Discount Total Total Tuition after Discounts Registration Deposit -$350. Balance Due -$ $ $ PAYMENT METHOD DEPOSIT Check one: o check # o credit card - (circle one) VISA MASTERCARD o cash TUITION BALANCE Check one: o Full Payment o Payment Plan If you wish to set up a fee-free Payment Plan, please call us to speak to an enrollment counselor. I understand that if I am accepted into the program, I am and agree to be legally obligated to pay the full tuition. Your Signature: Date: Processed by (office use only):
CREDIT CARD AUTHORIZATION NAME as it appears on Credit Card: BILLING ADDRESS: DAY PHONE: ALTERNATE PHONE: EMAIL ADDRESS: CREDIT CARD NUMBER: VISA MASTERCARD (circle one) CVV NUMBER: EXPIRATION DATE BILLING INSTRUCTIONS: DEPOSIT FULL PAYMENT MONTHLY PAYMENT thru / /201 ITEMS TO BE CHARGES CIRCLE ONE OF EACH TUITION FEES Yes No DEPOSIT FOR TUITION Yes No MONTHLY TUITION PAYMENT Yes No MERCHANDISE Yes No By my signature below, I hereby authorize Golden Gate School of Feng Shui to charge the above designated expense(s) to the credit card for shown above. I further state that I am authorized to commit such charges to the above designated account. SIGNATURE: DATE: Please include a signed photo copy of the back and front of your card.
Important Application & Registration Instructions 1. Fill out Application and Registration Form and submit to GGSFS with a $350 deposit. 2. Submit Personal Statement within two days of date of Application. Acceptance to the program is contingent upon receipt of these documents. 3. Within five days of receipt of all materials, your application will be reviewed and responded to by the school. If you are not accepted into the program, your deposit of $350 will be returned to you in full within 30 days. 4. Once accepted, return payment and all other applicable documentation to GGSFS within five days in order to complete your registration. This may include but is not limited to: payments, photos, enrollment agreement, payment plan agreements, credit card authorization forms, copies of credit cards, post-dated checks, and any other applicable agreements or forms. Specific instructions to complete your registration will be included with your acceptance letter and registration packet. Agreements, Refunds & Cancellations If you decide to cancel your application within seven days of submission, we will refund your deposit in full. If you decide to cancel once accepted into the program, and up to 30 days prior to commencement of the program, you will forfeit your $350 registration fee. Any early registration discounts will be held as a credit with the school for up to two years. Your balance will be refunded within 30 days of cancellation. Should you withdraw or discontinue your participation in the program less than 30 days prior, or once the program has commenced for any reason other than exceptional or catastrophic circumstances (to be determined by the discretion of GGSFS), you will receive course credit for up to two years, minus a $350 non-refundable registration fee. For full details of all cancellation policies please visit our website. All dates and teachers may be subject to change in the event of unforeseen circumstances. I have read, acknowledged and agree to the Application & Registration Instructions above, as well as the the Refund and Cancellation Policy above. Signature Date This is an intensive 9-month training program and individual success is dependent upon self-discipline and focused learning. My signature below represents a commitment to both the Golden Gate School of Feng Shui and to myself to read all required class materials before each module in order to be adequately prepared. I certify that the information provided by me on this application is true and correct to the best of my knowledge. If any of the information on this application changes between now and the end of the program at GGSFS, I will notify the Enrollment Office. I realize that failure to submit all applicable documentation as outlined above may result in the revocation of my acceptance into the program. If accepted, I agree to abide by all rules and regulations in effect during my enrollment. I understand that submission of fraudulent documents, misrepresentation or deliberate omission of any relevant information in the application process may be cause for rejection of the candidate, or, if enrolled, revocation of admission. I understand that GGSFS reserves the right, without notice, to modify the requirements for admission or graduation; to change the arrangement or content of courses, the instructional materials used; to change teachers; to alter any regulations affecting the student body; to refuse admission or readmission to any student at any time; or to dismiss any student at any time for inappropriate behavior or behavior that may be disruptive to the learning experience of fellow students. Signature Date Upon receipt of your admissions application and registration, confirmation will be e-mailed to you.