THE AMERICAN COLLEGE OF POSITIVE PSYCHOLOGY
You may print this form, complete it, scan it, and email. Or. you may copy and paste it into your email, complete it, and email it.
Or, you may simply provide the answers to the questions from the form in your email and send.
Payment is by Visa, MasterCard, or American Express
You may enroll by phone or email
If you enroll by email, simply provide the information requested below in your email
Phone 202-379-2840
Name: _________________________________________________________________________
Program/Degree Selection: _______________________________________________________
Mailing Address: ________________________________________________________________
Email Address: _________________________________________________________________
Phone Number: _________________________________________________________________
Fax Number: _____________________________________________________________________
Occupation: _____________________________________________________________________
Prior Education/Degrees/Certifications/Training/Diplomas/Seminars
__________________________________________________________________________________
__________________________________________________________________________________
Payment Information for $98 Annual Membership Fee and Tuition
Name on Card: ____________________________________________________________________
Address of Card Holder: ____________________________________________________________
Credit or Debit Card Number: ________________________________________________________
Expiration Date: ___________________________________________________________________
Security Code: ____________________________________________________________________
I authorize payment of the $98 Membership Fee. Please initial here: _______
I authorize The American College of Positive Psychology to charge my credit or debit
card for the payment checked below. Please initital here: ________
Discounted tuition after application of the $3,000 Tuition Scholarship Grant
PAYMENT PLANS ARE AVAIALBLE TO ALL STUDENTS. YOU MAY CHOOSE FROM
2 PAYMENTS UP TO 12 PAYMENTS. SIMPLY ADD A $50 MONTHLY SERVICE FEE TO EACH
INSTALLMENT PAYMENT.
Selected payment plan, if any: ______________________________________________________
_________________________________________________________________________________
$98 Enrollment/Membership Fee is in addition to tuition
Program/Degree Selection: _______________________________________________________
Mailing Address: ________________________________________________________________
Email Address: _________________________________________________________________
Phone Number: _________________________________________________________________
Fax Number: _____________________________________________________________________
Occupation: _____________________________________________________________________
Prior Education/Degrees/Certifications/Training/Diplomas/Seminars
__________________________________________________________________________________
__________________________________________________________________________________
Payment Information for $98 Annual Membership Fee and Tuition
Name on Card: ____________________________________________________________________
Address of Card Holder: ____________________________________________________________
Credit or Debit Card Number: ________________________________________________________
Expiration Date: ___________________________________________________________________
Security Code: ____________________________________________________________________
I authorize payment of the $98 Membership Fee. Please initial here: _______
I authorize The American College of Positive Psychology to charge my credit or debit
card for the payment checked below. Please initital here: ________
Discounted tuition after application of the $3,000 Tuition Scholarship Grant
1. MASTER'S DEGREE AND BOARD CERTIFIED PRACTITIONER: __________
Board Certified Practitioner (R) AND Master of Positive Psychology (MPPsy) (R)
Educational Prerequisite is Bachelor's degree in any field or the Equivalent
Investment: $5,291 ($8,291)
2. DOCTOR'S DEGREE AND BOARD CERTIFIED DIPLOMATE: ___________
Board Certified Diplomate (R) AND Doctor of Positive Psychology (DPPsy) (R)
Educational Prerequisite is Master's degree in any field or the Equivalent
Investment: $6,291 ($9,291)
Educational Prerequisite is Bachelor's degree in any field or the Equivalent
Investment: $5,291 ($8,291)
2. DOCTOR'S DEGREE AND BOARD CERTIFIED DIPLOMATE: ___________
Board Certified Diplomate (R) AND Doctor of Positive Psychology (DPPsy) (R)
Educational Prerequisite is Master's degree in any field or the Equivalent
Investment: $6,291 ($9,291)
2 PAYMENTS UP TO 12 PAYMENTS. SIMPLY ADD A $50 MONTHLY SERVICE FEE TO EACH
INSTALLMENT PAYMENT.
Selected payment plan, if any: ______________________________________________________
_________________________________________________________________________________
$98 Enrollment/Membership Fee is in addition to tuition
CANCELLATION POLICY
1. The membership fee is nonrefundable.
2. Once the proprietary product and services guide, Positive Psychology Program
Overview, has been released to the student by email attachment, there is no refund.
I agree with all of the above terms and conditions. Please enroll me as a member
of The American College of Positive Psychology.
Sign Your Name____________________________________________________________________
Date______________________________