UMMAHAATUL MU’MINEEN INSTITUTE (UMMI) 2022-23 TUITION FORM

A payment agreement form must be completed by every individual or family at the start of each semester. (Any applicable discounts should be discussed with the admission’s advisor prior to the completion of this form.) If we do not receive this form and you already have a payment plan in place, the existing plan will continue until you notify us otherwise. At Ummahaatul Mu’mineen Institute (UMMI) the contribution of fees by parents and guardians is essential to the institute’s ability to provide and resource its educational program. Fees can be paid in full or installments.

Name(s) of Students Under this Plan

*First Name

*Last Name

Course(s) of Enrollment (Please list for each enrollee)

Courses

*Phone NumberPlease Enter a Valid Phone Number

*Emailexample@example.com

*School Yeare.g 2020, 2021, 2022

Address

*Street Address

*Street Address Line 2

*City

*State/Province

*Postal/ Zip Code

Parent/Guardian Name (if applicable)

*First Name

*Last Name

*Parent/Guardian Phone NumberPlease enter a valid phone number.

*Parent/Guardian Emailexample@example.com

*Select the preferred plan (Note-Only monthly plans are available after January):

Plan D

Plan D $ 80

Plan D I would like to pay by monthly installments. I understand that with this option, payments must be made on the 10th of every month. In the event I enroll this month after the specified date, the same amount will be due immediately.

Payment Method

PayPal (Preferred

Zelle

Cash App

Other

Payment Details

I understand that payments must be made according to the details on this statement and that my first invoice will include or be preceded by the mandatory enrollment fee. I agree to the terms and will contact the institute with any further questions or concerns. https://docs.google.com/document/d/1DHPUdnElhK0LW9PexAQup6M7TDInW9m1_zW_4QFI5WA/edit

“I hereby declare that the details and information given above are complete and true to the best of my knowledge”. *

*Date Signed