UMMAHAATUL MUMINEEN INSTITUTE (UMMI) 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

First Name

*Last 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

*Tuition: Enter the lump sum or initial installment amount (if applicable) mentioned via email to indicate your planEnrollment fees should be submitted prior to 09/01. Monthly payments are due the tenth of every month; Semester payments are due the first of September; Termly payments are due the 1st of September, December, March and May.

Payment Method

PayPal (Preferred

Zelle

Cash App

Other

Payment Details (email/number etc to receive invoice)

I understand that payments must be made according to the details on this statement (read here: https://docs.google.com/document/d/1DHPUdnElhK0LW9PexAQup6M7TDInW9m1_zW_4QFI5WA/edit) 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. *

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

*Date Signed