Student Payment

This form is dedicated JUST FOR STUDENTS ENROLLED in FHI and want to make a payment for the remaining balance.

Este formulario está dedicado SOLO PARA ESTUDIANTES INSCRITOS en FHI y desean realizar un pago por el saldo restante.

Student Name *

Phone *

Email *

Program / Course Enrolled *

Please insert the course you will like to make a payment.

Predifined Amount

• $80.00
• $160.00
• Other Amount

Recommended Minimum Amount is $80.00

Total

$ 0.00

Stripe Credit Card *

Card

Name on Card

Disclosure *

• I authorize Florida Health Institute to initiate an electronic payment in the amount specified from the bank account on this record. I also authorize my financial institution to honor this electronic payment.

Submit