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All Fields Are Required |
Full Name:
format: first mi last, title |
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| Email: (same used for Paypal) |
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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.
All funds are in US Dollars.
No refunds are given for any reason and all payments are due, regardless
of the length of enrollment.
An Annual Report and Annual Report Fee of $100 is required yearly to maintain active status.
A $275 rebate will be awarded upon graduation to students who are never late with
Annual Reports or Annual Report Fees, AND have satisfied all financial responsibilities to AAMI.
This rebate is available only to enrollees in good standing. Returned checks void the rebate.
Enrollment may be terminated, without refund, if I fail to submit my Annual Reports (2 probation notices precede termination).
All initial deposits, fees or payments in full that are not wire transferred
should be made in the form of Cashier's Check, Money Order, or PayPal (US funds only).
Personal checks will result in a 30 day delay while waiting for the check to clear.
The Study Guide (Curriculum) remains the property of Ancient Art Midwifery Institute and must be returned upon the termination of enrollment for any reason.
Students are required to sign and submit a notarized form stating that they understand that the curriculum remains the property of AAMI,
that they are not allowed to copy, forward, sell or share the curriculum and that they agree to return the curriculum to AAMI at the end of their enrollment.
Initial enrollment is 42 months. Extensions are granted at the discretion of the director and there are no Leaves of Absence granted. Some courtesy extensions may be granted, but the standard fee for extensions is $60 per month or $600 a year. Failure to request an extension one month prior to the Projected Completion Date will result in an additional $40 per month charge. If the PCD passes, extensions will not be granted and re-enrollment is the only option.
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, 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 enrollment for any reason.
A collection agency will pursue all legal avenues of collection for any fees not
paid or checks not honored.
Any checks that do not clear and are not collectable will be turned over to law enforcement agencies who prosecute “hot checks.”
There is a US $50 fee for EVERY returned check or declined charge.
After a second incident, payment of the entire balance is due in full within 10 days.
There is a $300 testing fee for the required final exams.
Other fees will be incurred during enrollment.
By signing this form you acknowledge that you have read our Fees page and understand what fees will be required of you.
If you are unable to make payment in full, we offer a 0% interest payment option.
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. 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.
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 $100 for additional mailing costs.
Add $30 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 $300 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 (Midwifery Scholastic
Achievement Test) 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 a 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 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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