Professional Chef Certification Enrollment

I. Student Information

• Student Name _* First M Last Suffix
• Email Address _*
• Address _*
  Street Address Address Line 2 City State / Province / Region Postal / Zip Code
  Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Country
• Home Phone ( ) -
• Mobile Phone ( ) -
• Fax Line ( ) -
• Gender
  Male Female

II. Selection of Course

• The course descriptions and course start dates are stated in the 105degrees Academy Course Catalog and its Addendum (hereinafter collectively "Catalog"), as may be
  amended from time to time and which are incorporated herein by reference. The undersigned
  acknowledges and agrees that acceptance of this Agreement by 105degrees, and
  the Student's enrollment and attendance at 105degrees, are conditioned on the Student
  having satisfied all course prerequisites as stated in the Catalog, or having received in writing
  from an authorized official of 105degrees a waiver of the course prerequisites.
  
  Students seeking a waiver of the course prerequisites must request such waiver IN WRITING,
  detailing the basis for such request. Such requests must be sent to 105degrees at P.O. Box
  60886, Oklahoma City, OK 73146. The undersigned acknowledges that 105degrees may
  accept or deny such request in its sole judgment and determination. Responses to such
  requests will be made to the Student in writing, and a non-response within 30 days of the
  request shall be deemed a denial of such request.
• Please Select Desired Course:*
  Level I: Fundamentals of Raw Cuisine | $3,625
  Level II: Advanced Raw Cuisine | $8,425
• Level I Session
  09/08/09 - 10/02/0910/05/09 - 10/30/0911/02/09 - 11/24/0911/30/09 - 12/22/0901/04/10 - 01/29/1002/01/10 - 02/26/1003/01/10 - 03/26/1004/05/10 - 04/30/1005/03/10 - 05/28/1006/01/10 - 06/25/1007/05/10 - 07/30/1008/02/10 - 08/27/1008/30/10 - 09/24/1009/27/10 - 10/22/1010/26/10 - 11/19/1011/29/10 - 12/22/10

  Select Desired Course and Session.

• Level II Session
  01/04/10 - 03/26/1004/05/10 - 06/25/1007/05/10 - 09/24/1009/27/10 - 12/22/10

  Select Desired Course and Session.

• Level II Group
  Day Night
• If the Session you have chosen is unavailable, do you have a second choice in which you would like to enroll?
  Yes, please enroll me in my second choice session, which is:

  09/08/09 - 10/02/0910/05/09 - 10/30/0911/02/09 - 11/24/0911/30/09 - 12/22/0901/04/10 - 01/29/1002/01/10 - 02/26/1003/01/10 - 03/26/1004/05/10 - 04/30/1005/03/10 - 05/28/1006/01/10 - 06/25/1007/05/10 - 07/30/1008/02/10 - 08/27/1008/30/10 - 09/24/1009/27/10 - 10/22/1010/26/10 - 11/19/1011/29/10 - 12/22/10 01/04/10 - 03/26/1004/05/10 - 06/25/1007/05/10 - 09/24/1009/27/10 - 12/22/10

  No, I do not wish to enroll in an alternative session at this time.

III. Tuition and Fees

• In consideration of the acceptance of this Agreement by 105degrees, the undersigned
  agrees to pay the application fee of $25 for this Student, together with tuition and the
  student kit fee in the amount set forth below:
• Application Fee
  Application Fee $25
• Base Costs
  Level I: Fundamentals of Raw Cuisine / 120 Contact Hrs / $3,625 Level II: Advanced Raw Cuisine / 420 Contact Hours / $8,425
• Student Kit: Level I
  The Germinators $675: If you've never taken a 105degrees course then you're a Germinator.
• Student Kit: Level II
  The Bloomers $270 The Perennials $845 The Transplants $945
• Total Cost of Enrollment: $0

IV. Payment Options for Tuition and Fees

• The undersigned must submit Tuition, a $25 Application Fee, and the applicable Student Kit Fee with this Entrance and Enrollment Agreement. 105degrees accepts cash, checks, money orders, and credit card (Visa, Mastercard, and American Express) payments for payment of tuition and all other fees.
• I have read and understood the information detailed in this section.

V. Compliance with Rules, Policies, and Regulations

• The undersigned agrees to comply with the policies, rules, and regulations of 105degrees, as stated in the Catalog, as may be amended from time to time and which is incorporated herein by reference, and as otherwise may be posted or provided. The undersigned acknowledges and agrees that acceptance of this Agreement by 105degrees, and the Student's enrollment and attendance at 105degrees, are conditioned on compliance with such policies, rules, and regulations by the Student. Each of the undersigned further acknowledges and agrees that 105degrees may dismiss the Student, withdraw an offer of enrollment, or decline to re-enroll the Student, if in the sole judgment of 105degrees the Student's conduct, influence, industry or progress is unsatisfactory. In the event of dismissal, the undersigned remains obligated to pay tuition and fees for the course in which he or she is enrolled as provided in section VI below. Acceptance of this Agreement does not constitute a promise or agreement to offer re-enrollment for additional or future courses or classes at 105degrees.
• I have read and understood the information detailed in this section.

VI. Non-Acceptance, Cancellation or Dismissal

• A student may cancel his or her enrollment by giving WRITTEN notice to 105degrees of such cancellation by certified mail at P.O. Box 60886, Oklahoma City, OK 73146. Neither a request for records nor nonpayment constitutes written notice of cancellation. Failure to provide such notice in writing as required will result in a $25 Cancellation Penalty. In cases of cancellation or dismissal, 105degrees will refund monies paid to it by the student as set forth below within 30 days after cancellation or dismissal. The termination date and time, for the purpose of refund computation, is the last contact hour attended on the final date of actual course attendance by the student.
  
  REJECTION: An applicant rejected by 105degrees will be refunded all monies paid minus $25.00.
  
  THREE-DAY CANCELLATION: All monies paid by an applicant will be refunded if requested within three days after signing an entrance and enrollment agreement and making an initial payment.
  
  OTHER CANCELLATION: An applicant subsequently requesting cancellation will receive a refund of all monies paid minus a registration fee of 15% of the contract price of the course, but not more than $150.00.
  
  FIRST WEEK: For a student terminating training after the Three-Day Cancellation, after entering school and starting the course of training but within the first week, the student will receive a refund of 90% of the contract price of the course minus $150.00 but in no event more than $350.00. This "First Week" refund provision does not apply to courses of four weeks or less.
  
  AFTER FIRST WEEK: For a student terminating training after one week but within the first 25% of the course, the student will receive a refund of 75% of the contract price of the course minus $150.00.
  
  AFTER 25%: For a student terminating training after completing over 25% but within 50% of the course, the student will receive a refund of 50% of the contract price of the course minus $150.00.
  
  AFTER 50%: A student completing more than 50% of the course will not receive a refund.
  
  SPECIAL CASES: In case of student prolonged illness or accident, death in the family, or catastrophic event, the student may request a settlement which is reasonable and fair to 105degrees and the student. The school will make a refund that is reasonable and fair to both the school and the student.
  
  DISCONTINUED CLASS: If a class is discontinued by 105degrees while students are still enrolled in that class, and 105degrees is still offering training in other areas, all monies paid 105degrees for students enrolled in the class at the time it is discontinued will be refunded to the entity legally entitled to the refund. 105degrees will have 30 days
  to restart the class or pay the refund.
  
  EXTRA EXPENSES: The Student Kit Fees set forth in the Entrance and Enrollment Agreement and the Course Catalog Addendum shall not be considered in tuition refund computations. There is no refund of the Student Kit Fees upon purchase and acceptance of their contents, which includes the students' manuals, personally customized uniforms, and knife sets.
• I have read and understood the information detailed in this section.

VII. Arbitration, Attorney's Fees, and Limitation of Liability

• All claims or disputes arising out of or relating to this Agreement, except for actions by 105degrees to collect any amount owing under this Agreement, and all claims and disputes arising out of or relating in any way to the Student's enrollment or attendance at 105degrees, shall be decided by arbitration in accordance with the rules of the American Arbitration Association.
  
  Any holder of this consumer credit contract is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof, recovery hereunder by the debtor shall not exceed amounts paid by the debtor hereunder.
  
  THE UNDERSIGNED AGREES TO REIMBURSE 105degrees FOR ANY LEGAL FEES AND COSTS INCURRED BY 105degrees FOR THE ENFORCEMENT OF THIS AGREEMENT AND THE COLLECTION OF OUTSTANDING BALANCES OWED UNDER THIS AGREEMENT. IN NO EVENT WILL 105degrees BE LIABLE FOR ANY SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES IN ANY ACTION OR PROCEEDING ARISING OUT OF OR IN CONNECTION WITH THIS AGREEMENT, WHETHER SOUNDING IN CONTRACT, TORT OR OTHERWISE.
• I have read and understood the information detailed in this section.

VIII. Nondiscrimination Policy

• 105degrees admits students of any race, color, religion, or national and ethnic origin. 105degrees does not discriminate on the basis of race, color, religion, or national and ethnic
  origin in administration of its educational policies and other school-administered activities.
• I have read and understood the information detailed in this section.

IX. Applicable Law

• This Agreement shall be interpreted and construed in accordance with the laws of the State of Oklahoma.
• I have read and understood the information detailed in this section.

X. Emergency Contact Information

• Person's Name First Last
• Phone Number ( ) -

XI. Student Citizenship and Level of Education

• Student Citizenship Status:
  United States Citizen Permanent Resident Other
• If "Other", country of current citizenship:
• If "Other", country of birth:
• Are you currently in the U.S?
  Yes No
• If you are in the U.S. and are not a U.S. citizen or permanent resident, please indicate the type of Visa you currently hold:
• Do you speak, write and understand English fluently?
  Yes No

• Educational Background

  Admission to 105degrees requires satisfaction of one of the three minimum educational
  requirements below.
• Please check the requirement(s) that the Student satisfies:
  High school diploma or GED certificate Prior acceptance of admission in a technology center currently accredited by the Oklahoma Board of Career and Technology Education Prior acceptance of admission in a private vocational school currently licensed by the Oklahoma Board of Private Vocational Schools.

XII. Constent and Release

• I hereby consent that 105degrees and its agents, employees, successors, and assigns, may, for advertising or trade purposes, use any photograph, film, video tape or audio recording taken or recorded of me, either alone or in conjunction with photographs, films, video tapes, or audio recordings of other persons, objects, or materials. This consent includes the right to make alterations to and retouch photographs, films, and recordings.
• Initial here:*

XIII. Student Uniform and Knife Set Selection

• Please select your size for each item in the corresponding box.
  
  Refer to the Student Uniform Sizing Chart in the Catalog when making size selections. There are no returns or refunds based on an improper sizing. Uniforms are personally customized, and the student purchases and accepts them upon selection and payment with this agreement.
• Write Your Name* as you would like it to appear on your uniform:

  * We are not responsible for misspellings. Please print clearly.

• Eco-Friendly Chef Coat
  XS S M L XL 2X 3X 4X 5X
• Ultimate Organic Pant
  XS S M L XL 2X 3X 4X 5X
• Endurance Clogs (Female)
  N/A 5 6 7 8 9 10 11 12
• Endurance Clogs (Male)
  N/A 7 8 9 10 11 12 13
• Knife Kit: Indicate Right or Left Handed
  Left Right

XIV. Personal Background Questions

• A. How did you learn about 105degrees?
• B. Have you attended one or more previous courses at 105degrees? If so, please list the courses and dates of attendance.
• C. Why do you wish to learn about raw and living cuisine at 105degrees?
• D. What are your goals and aspirations following course completion?
• E. List any previous raw and living cuisine instruction, including the name of the course and instructor, and the name and location of the educational institution:
• G. List any physical limitations, allergies, conditions, or sickness that may affect full course participation:
• Do Not Fill This Out