Enroll Now"*" indicates required fieldsStep 1 of 911%I hereby apply for enrollment in DATS of Florida, Inc., hereinafter referred to as “School.” A representative has provided me with a catalog, explained the programs, terms of the Enrollment Agreement, and awarding of a Diploma on completion. I am 18 years or older.08/27/2026Select CampusSelect Campus* Temple Terrace Fort Myers Ocoee Ocala Kendall West Palm Beach BradentonStudent InformationFirst Name*Last Name*Date of Birth*This field is hidden when viewing the formDate of Birth (administrative) MM slash DD slash YYYY Social Security #*Gender*SelectMaleFemaleThis field is hidden when viewing the formAge*Ethnicity*SelectWhiteBlackHispanicAsian/PacificAmerican IndianResidency*SelectFlorida ResidentOther StateInternational StudentSpecify State*This field is hidden when viewing the formAge 16-17This field is hidden when viewing the formAge 18-25This field is hidden when viewing the formAge 26-44This field is hidden when viewing the formAge Over 44Contact InformationAddress*City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZip Code*Cell Phone*Email* Level of education at the start of your program.Level of Education* High School Graduate GED Some College A.S. or A.A. B.A. or B.S. OtherSpecify*Name of School*City*State*SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificAlternative Contact DetailsName of Closest Relative*Relationship*Cell Phone*How Did You Hear About UsHow Did You Hear About Us* Google Social Media Newspaper Catalog Flyer/Other Employer/Friend OtherName of the Referral*Select Your ProgramSelect Your Program* Entry Level Dental AssistingTraining focuses solely on the fundamental knowledge and skills needed to work in a dental office. Students learn in an actual dental office and get familiar with the work environment before their first day on the job.9 Weeks$2,67572 Clock Hours Select Program Selected Entry Level Dental Assisting + Expanded Duties*Final two weeks for the Expanded Duties Program will be completed at the Bradenton, West Palm Beach, or Ft Myers school location.11 Weeks$3,375150 Clock Hours*Includes 30 hour externship Select Program SelectedSelect Your SessionSession Year* 2026Session 2024* Winter (Jan – Mar) Spring (Apr – Jun) Summer (Jul – Sep) Fall (Oct – Dec)ProgramEntry Level Dental AssistingCourse Hours72 hoursCourse Weeks9 weeksStart Date01/13/2026 | 01/12/2026Completion Date03/06/2026This field is hidden when viewing the formWinter 2026 Start Date ShortThis field is hidden when viewing the formWinter 2026 End Date ShortThis field is hidden when viewing the formWinter 2026 End Date LongProgramEntry Level Dental AssistingCourse Hours72 hoursCourse Weeks9 weeksStart Date04/07/2026 | 04/06/2026Completion Date06/04/2026This field is hidden when viewing the formSpring 2026 Start Date ShortThis field is hidden when viewing the formSpring 2026 End Date ShortThis field is hidden when viewing the formSpring 2026 End Date LongProgramEntry Level Dental AssistingCourse Hours72 hoursCourse Weeks9 weeksStart Date07/08/2026 | 07/06/2026Completion Date09/03/2026This field is hidden when viewing the formSummer 2026 Start Date ShortThis field is hidden when viewing the formSummer 2026 End Date ShortThis field is hidden when viewing the formSummer 2026 End Date LongProgramEntry Level Dental AssistingCourse Hours72 hoursCourse Weeks9 weeksStart Date10/06/2026 | 10/05/2026Completion Date12/04/2026This field is hidden when viewing the formFall 2026 Start Date ShortThis field is hidden when viewing the formFall 2025 End Date ShortThis field is hidden when viewing the formFall 2025 End Date LongThis field is hidden when viewing the formEnd Date Short (used for pdf creation)This field is hidden when viewing the formEnd Date Long (used for pdf creation)ProgramEntry Level Dental Assisting + Expanded DutiesCourse Hours150 hoursCourse Weeks11 weeksStart Date04/07/2026 | 04/06/2026Completion Date06/18/2026ProgramEntry Level Dental Assisting + Expanded DutiesCourse Hours150 hoursCourse Weeks11 weeksStart Date07/07/2026 | 07/06/2026Completion Date09/17/2026ProgramEntry Level Dental Assisting + Expanded DutiesCourse Hours150 hoursCourse Weeks11 weeksStart Date10/06/2026 | 10/05/2026Completion Date12/04/2026ProgramEntry Level Dental Assisting + Expanded DutiesCourse Hours150 hoursCourse Weeks11 weeksStart Date01/13/2026 | 01/12/2026Completion Date03/20/2026Payment OptionsPayment Options (Entry Level)* Option 1(Guarantees Enrollment) I choose to pay the tuition in the following manner:Payment in Full(Tuition of $2,675) Select Selected Option 2(Guarantees Preliminary Enrollment) I choose to pay the tuition in the following manner:Deposit of $200.00 I agree to pay the balance of $2,475 two (2) weeks prior to the beginning of class. Select Selected Option 3(Guarantees Preliminary Enrollment) I agree to pay my tuition by means of a payment plan:Deposit of $500.00 I agree to pay the balance of $2,175.00 according to my payment plan. Nine weekly payments of $241.66 @ 0% interest. Select Selected Option 4(Guarantees Preliminary Enrollment)I agree to pay my tuition by means of a loan:Deposit of $500.00 I agree to pay the balance of $2,175.00 according to my loan. Six monthly payments of $382.45 @ 18.99% interest. Select SelectedPayment Options (Advanced Level)* Option 1(Guarantees Enrollment) I choose to pay the tuition in the following manner:Payment in Full(Tuition of $3,375) Select Selected Option 2(Guarantees Preliminary Enrollment) I choose to pay the tuition in the following manner:Deposit of $200.00 I agree to pay the balance of $3,175 two (2) weeks prior to the beginning of class. Select Selected Option 3(Guarantees Preliminary Enrollment)I agree to pay my tuition by means a payment plan:Deposit of $500.00 I agree to pay the balance of $2,875.00 according to my payment plan. 11 weekly payments of $261.36 @ 0% interest. Select Selected Option 4(Guarantees Preliminary Enrollment)I agree to pay my tuition by means of a loan:Deposit of $500.00 I agree to pay the balance of $2,875.00 according to my loan. Six monthly payments of $506.06 @ 18.99% interest. Select SelectedThis field is hidden when viewing the formRecurring payment flagThis field is hidden when viewing the formisEntryThis field is hidden when viewing the formisAdvancedThis field is hidden when viewing the formRecurring days weekThis field is hidden when viewing the formRecurring days monthOption 1 – Pay in Full(Guarantees Enrollment)Option 2 – Pay Deposit now and the balance two weeks prior to class(Guarantees Preliminary Enrollment)Option 3 – Pay Deposit now and pay the remaining balance by means of a payment plan.(Nine weekly payments of $241.66 at 0% interest)Option 4 – Pay Deposit now and pay the remaining balance by means of loan(Six monthly payments of $382.45 at 18.99% interest)Option 1 – Pay in Full(Guarantees Enrollment)Option 2 – Pay Deposit now and the balance two weeks prior to class(Guarantees Preliminary Enrollment)Option 3 – Pay Deposit now and pay the remaining balance by means of a payment plan.(Eleven monthly payments of $261.36 at 0% interest)Option 4 – Pay Deposit now and pay the remaining balance by means of loan.(Six monthly payments of $506.06 at 18.99% interest)Entry – Option 1 Payment* Pay in Full Today$2,675 Full TuitionEntry – Option 2 Payment* Pay Deposit Today($200 – Guarantees Preliminary Enrollment) $100 Registration Fee(Enrollment Not Guaranteed)This field is hidden when viewing the formI agree to pay the balance of 2475 2 weeks before the classEntry – Option 3 Payment* Pay Deposit Today($500 – Guarantees Preliminary Enrollment) $100 Registration Fee(Enrollment Not Guaranteed)Entry – Option 4 Payment* Pay Deposit Today($500 – Guarantees Preliminary Enrollment) $100 Registration Fee(Enrollment Not Guaranteed)Weekly Subscription – BasicMonthly Subscription – BasicThis field is hidden when viewing the formAgree to pay 2175 according to my payment planThis field is hidden when viewing the formAgree to pay 2175 according to my loanAdvanced – Option 1 Payment* Pay in Full Today$3,375 Full TuitionAdvanced – Option 2 Payment* Pay Deposit Today($200 – Guarantees Preliminary Enrollment) $100 Registration Fee(Enrollment Not Guaranteed)This field is hidden when viewing the formDeposit of $200.00This field is hidden when viewing the formI agree to pay the balance of 3175 2 weeks before the classAdvanced – Option 3 Payment* Pay Deposit Today($500 – Guarantees Preliminary Enrollment) $100 Registration Fee(Enrollment Not Guaranteed)Advanced – Option 4 Payment* Pay Deposit Today($500 – Guarantees Preliminary Enrollment) $100 Registration Fee(Enrollment Not Guaranteed)Weekly Subscription – AdvancedMonthly Subscription – AdvancedThis field is hidden when viewing the formAgree to pay 2875 according to my payment planThis field is hidden when viewing the formAgree to pay 2875 according to my loanThis field is hidden when viewing the formDeposit of $500.00 (payment plan)This field is hidden when viewing the formDeposit of $500.00 (loan)Product Name TestEven out weekly basicEven out monthly basicEven out weekly advancedEven out monthly advancedTotal This field is hidden when viewing the formDeposit FlagThis field is hidden when viewing the formRegistration Fee FlagRefund and Cancellation PolicyShould an applicant/student cancel or is terminated for any reason, all refunds will be made according to the following policy and schedule: 1. All moneys will be refunded if the applicant is not accepted by the School or if the applicant cancels within three (3) business days after signing the Enrollment Agreement and making initial payment. An applicant not requesting cancellation by his/her specified starting date will be considered a student. 2. Cancellation must be made in person or by certified mail. 3. Termination date for refund computation purposes, is the last date of actual attendance by the student, unless earlier written notice is received. 4. Refunds will be made within 30 days of termination or receipt of Cancellation Notice. 5. Should a student be terminated or request cancellation of this Enrollment Agreement after: a] The third (3rd) business day, but before the first class, will result in a refund of all moneys paid, with the exception of the Registration Fee in the amount of $50.00, b] entering the program of training but prior to 50% completion of the Program, the tuition charges made by the School to the student shall not exceed 50% of the Tuition Cost plus the Registration Fee. The refund will be computed on a pro rata basis on the number of hours completed to the total Program hours, c] completing 50% of the Program, student is not entitled to any refund as a matter of right and is obligated for the Total Program Cost. If the school cancels a program then the student will receive a full refund of monies paid.Other Terms and ConditionsA student may be terminated for creating a safety hazard to other students, disobedient or disrespectful behavior to faculty or other students, unsatisfactory academic progress, poor attendance, unprofessional conduct, excessive absence or lateness, failure to pay fees when due, cheating, falsifying records, breach of enrollment agreement, entering school site while under the influence or effects of alcohol, drugs, or narcotics, of any kind, carrying a concealed or potentially dangerous weapon or sexual harassment or harassment of any kind. Terms of the refund policy will apply. The School will provide its graduates with assistance and job leads upon graduation, but cannot guarantee job placement or employment.I have read the terms and conditions contained in this Enrollment Agreement and the catalog, which I have received and read, and understand that this agreement constitutes a binding contract upon written acceptance by the School.Student signature*Student SignatureDate08/27/2026Date08/27/2026Payment MethodPayment Method* Credit Card Check Grant/OtherSet up auto payment (required with weekly and monthly plans)* Set up auto payment (required with weekly and monthly plans)Specify Payment Method*Credit Card*Card Details Cardholder Name