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All Fields Are Required |
Full Name:
format: first mi last, title |
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| Email: |
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| Shipping Address: |
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| Mailing Address: |
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| City: |
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| State: |
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| Zip/Postal Code: |
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| Phone: |
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| Country: |
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| Present Occupation: |
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| Age: |
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| Marital Status: |
Single Married
Ages of Children: |
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| Average number of hours you plan to commit
to the course each week |
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| How long have you been studying midwifery on
your own? |
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| What birth related magazines or journals do
you regularly read? |
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| Will you have difficulty buying and/or borrowing
a large number of books? |
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| Approximate # of birth related books you have
read: |
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| Approximate # of birth related books you have
access to: |
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| Do you consider yourself, as a student: |
below average
average
above
average
excellent |
Graduate of:
High School |
Year: |
| Home School |
Year: |
| GED |
Year: |
| Vocational/Technical School |
Year: |
| College |
Degree: |
Currently Attending College
Currently Homeschooling
Nurse
Nursing Student |
at |
| Planning to eventually become a CNM |
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| Childbirth Educator |
Certified with? |
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If you are not currently practicing or apprenticing, do you
forsee any difficulty
in securing an apprenticeship?
Yes No |
If yes, please explain.
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| Approximate number of practicing midwives in
your state? |
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| Local area? |
Do you know them? |
| Is midwifery legal in your state? Explain: |
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| Licensing requirements, if any: |
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| Number of Pro Home Birth Doctors in your area: |
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| Number of Pro Home Birth Childbirth Educators
in your area: |
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| Are you a part of your state midwifery organization? |
Yes No |
| Courses you plan to take concurrently with
this one: |
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| Do you know other enrollees? |
No Yes Whom? |
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ENROLLMENT AGREEMENT
I understand and agree to the following:
Ancient Art Midwifery Institute reserves the right
to accept or reject any applicant. A telephone interview may
be required.
No refunds are given for any reason and all payments
are due, regardless of the length of enrollment.
An Annual Report and Annual Report Fees of $25 is
required yearly to maintain active status. A US $75 rebate will
be awarded upon graduation to students who are never late with
Annual Reports or Annual Report Fees. This rebate is available
only to those enrollees in good standing. Enrollment may be terminated,
without refund, if I fail to submit Annual Reports (2 probation
notices precede termination).
All initial deposits or payments in full that are
not wire transferred must be made in the form of Cashier's Check,
Money Order, or PayPal (US funds only).
A US $250 deposit (in addition to tuition) is required
upon request of the Study Guide. The Study Guide will not be
sent until this deposit has been received by AAMI. The Study
Guide remains the property of Ancient Art Midwifery Institute
and must be returned upon the termination of enrollment for any
reason. The US $250 deposit, plus and additional US $25, will
be returned to the student when the study guide is returned.
Students who withdraw on their PCD (projected completion date)
without having graduated, are not eligible for the additional
US $25. Students who withdraw prior to their PCD or who have
not met all financial obligations to AAMI are not eligible for
any refund of the curriculum return deposit. Should I fail to
return the study guide upon completion, expiration, or temination
of the program, I agree to forfeit my desposit of US $250.
Initial enrollment is 39 months. Extensions are granted
at the discretion of the director and there are no Leaves of
Absence granted.
Ancient Art Midwifery Institute reserves the right
to accept or reject any submitted work. Submissions will be returned,
at the student's expense, if grossly incorrect, undocumented,
unbound, or the student's file number is not on every page.
All AAMI material is copyrighted. It is illegal and
unethical to copy or share or sell course materials (it is necessary
for students to copy certain course forms and clear instructions
are provided that indicate which forms this exception pertains
to). The Study Guide remains the property of Ancient Art Midwifery
Institute and must be returned upon the termination of my enrollment
for any reason. I will forfeit my US $250 deposit if it is not
returned within one week after termination.
A collection agency will pursue all legal avenues
of collection of any fees not paid. Any checks that do not clear
and are not collectable will be turned over to law enforcement
agencies. There is a US $50 fee for EVERY returned check or declined
charge. After a third incident, payment of the entire balance
is due in full within 10 days.
There is a US$250 testing fee to cover the cost of
the required final exams. Fee is waived if student submits course
assignment within the first year.
If you are unable to make payment in full, we offer
0% interest payment options. A special payment agreement is required,
with Social Security number and a telephone interview with the
director before any payment plan can be approved. Balance is
paid in equal monthly payments over no more than 24 months. Keep
in mind that ALL payments are due regardless of length of enrollment.
Do not sign an agreement you do not fully intend to honor. An
additional charge of US $50 will be imposed per returned check
AND all uncollectible checks will be turned over to local check
collection authorities and/or independent collection agencies.
We can only continue to offer payment plans as long as enrollees
honor their word so we are very serious about this issue. We
do not make credit checks, but AAMI reserves the right to reject
any applicant of the Payment Program if we determine that there
is not sufficient intent to honor the agreement. For Payment
Program details and/or payment program code, contact Carla at
918-720-2717 or carla@ancientartmidwifery.com.
We no longer charge an additional mailing fee for
Canadians but residents outside of North America pay a one time
fee of $50 for additional mailing costs.
Add $23 for a PDF format ebook version of Helping
Hands, The Apprentice Workbook if you do not already own it.
Every requirement must be completed and the US$250
exam fee must be paid before a student becomes eligible for the
Certification Exam. In addition, a score of 70% or higher on
the MSAT must be achieved. Graduates receive either a Certificate
of Successful Completion, an Award of Academic Achievement or
an Award of Academic Excellence, determined by the quality of
work submitted.
All work submitted must be completed by the student
only and may not be the copy of another student's work.
In addition to the stipulations
above:
I realize that there will be expenses other than tuition
and the above mentioned fees and deposits. This includes, but
is not limited to, books, photocopying, postage, conference tapes
and supplies.
I understand that this course is intended as preparation
for, or complement to, practical experience under a supervising
midwife. AAMI may be able to provide assistance in locating a
preceptor but cannot make that guarantee.
I understand that this course demands a great deal
of time and study. What I learn depends on how much effort I
invest.
I will not, under any circumstance, misrepresent myself
as a qualified birth attendant based on enrollment in, or completion
of, this course alone. I am in complete agreement that my education
will not be complete without an apprenticeship and other forms
of practical experience.
I will not represent myself as a graduate until I
have the certificate in my possession.
SUBMISSION OF THIS FORM IS EQUIVALENT
TO SIGNING THIS DOCUMENT AND SHALL BE CONSIDERED LEGALLY BINDING.
PLEASE PRINT A COPY OF THIS COMPLETED FORM FOR YOUR RECORDS.
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I have read the entire AAMI website and understand and agree
to the stipulations of enrollment in Advanced Midwifery Studies.
I have made the decision to enroll fully aware that the course
is comprehensive and therefore time consuming, that books are
not provided with tuition, and that there will be no tuition
refunds for any reason. Once I have been approved and assigned
a file number, there will be no refunds or exchanges. The course
materials remain the property of AAMI and may not be shared,
copied or sold for any reason. If approved, enrollment benefits
commence immediately with the first instructions and proprietary
information via email. Initialing this space constitutes legal
signature.
Please type your initials in this box to indicate that you've
read and understood the agreement. Initialling this space constitutes
legal signature.
I have read and understand the Enrollment Agreement and agree
to the terms and conditions presented herein.
Initials:
Name:
Age:
Today's Date:
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Please double-check all your answers and be certain that you've
filled in each field. When you're ready, click the "Submit
Application" button below. Afterward, you'll see a page
verifying what was sent, which you should print for your records.
Once your application has been accepted, you may add options
later such as the Philomath Program, Childbirth Educator Certification,
Preceptor Verification Program (documents apprenticeship), extensions
and other options. Click on the link provided there to choose
your Course Options and Payment Plan, and make your first payment
on our secure server. We accept credit cards via PayPal ONLY
(you may use a credit card that you have on file with PayPal,
but we at AAMI do not process credit cards). We also accept wire
transfer and personal checks.
Cancellation Policy: Cancellation is possible
only in the first 72 hours after either payment or enrollment
form is received. Cancellation must be in writing and dated.
We do not process enrollments until the 72 hour limit has passed.
Carla
Hartley
Founder, Director
If you wish to pay by check(s) you must now PRINT THE APPLICATION
FORM AND MAIL IT to AAMI, PO Box 69, Foyil, OK 74031.
Do NOT enroll online -- DO NOT CLICK THE BUTTON BELOW -- unless
you are ready to provide PAYMENT IN FULL using PayPal. Regular
tuition is $3950. See Tuition page.
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