Please complete this e-mail form to initiate an Educational Assistance payment.
By signing above I agree that the information I provided is accurate.
I understand and agree that Loan Repayment in the amount of $2,000 will be amortized over the course of 12 months at the rate of $166.66 per month. If I terminate for any reason I agree to pay Fremont Health for the balance of my unamortized amount.
For example: If I receive a $2,000 payment on June 15th and I terminate 6 months later on Dec 15th I will own Fremont Health a balance of $1,000.
I also understand and agree that tuition reimbursement will be amortized over 12 months whereas the monthly amount will be determined by the amount of total tuition reimbursed.