Deposits
First Name
Last Name
Phone Number
Email Address
Date Of Birth MM/DD
Last 4 of SSN
Payment For
Enrollment and Housing - $300
Enrollment Only - $150
Housing Only - $150
International Enrollment Only - $500 (NON-REFUNDABLE)
International Enrollment and Housing - $650 (NON-REFUNDABLE)
Doctor of Physical Therapy Deposit - $1000 (NON-REFUNDABLE)
Physician Assistant Deposit - $500
Surgical Technology Deposit - $250
Student ID
Name on Credit Card
Billing Address
Billing City
Billing State
INTL - International
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District Of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Billing ZIP Code
Credit Card Type
Discover
MasterCard
Visa
Credit Card Number
Card Verification Number
Expiration Month
01
02
03
04
05
06
07
08
09
10
11
12
Expiration Year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
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