Payment Plan Contractual Agreement

Health Careers Training Institute (HCTI) • 1941 Bishop Lane, Suite 1004, Louisville, KY 40218

Student Information & Program Selection

Please review and complete the information below to finalize your payment plan.

Full Name *

Social Security Number *

Phone *

Email *

Program Enrolled In *

Program Start Date *

Create Account Password *

CNA (Days)

Total Tuition

$1,150

Deposit Applied

− $200

Plan Fee

+ $50

Total Plan Balance

$1000.00

Scheduled Weekly Payments:

Payment 1: 10 days before class$250.00

Payment 2: Week 2 (Friday)$250.00

Payment 3: Week 3 (Friday)$250.00

Payment 4: Week 4 (Friday)$250.00

3rd Party / Tuition Assistance Referral (Up to 50% Off)

Select if you have applied or plan to apply for 50% tuition assistance (must work 20+ hours/week).

I agree to HCTI's No Refund Policy. All payments made are non-refundable. *

Default & Acceleration: breach makes balance immediately due with $50 reinstatement fee. *

Automatic Card Auth: charge card on file for scheduled payments on due date. *

Binding Agreement: enforceable under Kentucky law. *

Confirm reading and agreeing to all terms of this Payment Plan Agreement. *

Electronic Signature — Type Your Full Name *

Handwritten Signature — Draw Below *

✍️ Sign here

Waive $50 Payment Plan Fee (Paid Separately)