{"id":2147,"date":"2016-05-17T10:24:21","date_gmt":"2016-05-17T17:24:21","guid":{"rendered":"http:\/\/www.breining.edu\/?page_id=2147"},"modified":"2020-02-29T12:15:28","modified_gmt":"2020-02-29T20:15:28","slug":"college-tuition-fees-payment","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/higher-education\/college-tuition-fees-payment\/","title":{"rendered":"College Tuition \/ Fees Payment"},"content":{"rendered":"<p class=\"p1\"><span class=\"s1\">You may submit a credit card payment for the College program\u00a0in which you are enrolled, or for which you are applying, using this form.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">You will be automatically sent an email confirming this submission, to the email address that is included in this form, once you have selected the \u201cSubmit\u201d button.<\/span><\/p>\n<p class=\"p1\"><span class=\"s1\">We will process this payment as soon as possible, typically within one business day.<\/span><\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-27\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-27\" value=\"1777544535\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"27\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 1: Student Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField602\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField603\"><div class=\"vfb-form-group\"><label for=\"vfb-field-603\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-603\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-603\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField604\"><div class=\"vfb-form-group\"><label for=\"vfb-field-604\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-604\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-604\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField605\"><div class=\"vfb-form-group\"><label for=\"vfb-field-605\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-605\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-605\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField606\"><div class=\"vfb-form-group\"><label for=\"vfb-field-606\" class=\"vfb-control-label\">Primary Phone Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-606\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" type=\"tel\" name=\"vfb-field-606\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 2: Program Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField607\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField609\"><label for=\"vfb-field-609\" class=\"vfb-control-label\">FAST TRACK Education Program<\/label><div><span class=\"vfb-help-block\">You may select more than one payment option, below. We will ADD ALL OF YOUR SELECTIONS, and will charge the total amount to the credit card you select for payment.<\/span><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-609-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-609\" type=\"checkbox\" name=\"vfb-field-609[0]\" value=\"1\">$663<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-609-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-609\" type=\"checkbox\" name=\"vfb-field-609[1]\" value=\"1\">$760.35<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-609-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-609\" type=\"checkbox\" name=\"vfb-field-609[2]\" value=\"1\">$802.75<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-609-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-609\" type=\"checkbox\" name=\"vfb-field-609[3]\" value=\"1\">Other payment, identified below in Section 3<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField610\"><label for=\"vfb-field-610\" class=\"vfb-control-label\">Addiction Studies Certificate (ASC) Program<\/label><div><span class=\"vfb-help-block\">You may select more than one payment option, below. We will ADD ALL OF YOUR SELECTIONS, and will charge the total amount to the credit card you select for payment.<\/span><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[0]\" value=\"1\">$292.35 - Series 1100 & Addiction Professional Manual (if enrolled prior to 1\/21\/2020)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-9\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[9]\" value=\"1\">$334.75 - Series 1100 & Addiction Professional Manual (if enrolled on or after 1\/21\/2020)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[1]\" value=\"1\">$195 - Series 1200<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[2]\" value=\"1\">$546 - Series 1300<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[3]\" value=\"1\">$390 - Counseling Series<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[4]\" value=\"1\">$117 - Series 1500<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[5]\" value=\"1\">$195 - Series 1600<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[6]\" value=\"1\">$117 - Series 1700<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[7]\" value=\"1\">$175 - Addiction Counselor Exam (ACE)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-610-8\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-610\" type=\"checkbox\" name=\"vfb-field-610[8]\" value=\"1\">Other payment, identified below in Section 3<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 3: Optional \/ Additional Payment<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField615\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField616\"><div class=\"vfb-form-group\"><label for=\"vfb-field-616\" class=\"vfb-control-label\">If you are going to make a payment in addition to or different than one or more of those included in Section 2, above, please itemize and explain your payment here:<\/label><div><textarea id=\"vfb-field-616\" class=\"vfb-form-control\" placeholder=\"\" rows=\"10\" name=\"vfb-field-616\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 4: Credit Card and Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField617\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField618\"><div class=\"vfb-form-group\"><label for=\"vfb-field-618\" class=\"vfb-control-label\">You give permission to and authorize Breining Institute to charge the total amount of the items selected in Section 3 and (if applicable) identified in Section 4, to the following credit card:<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField619\"><label for=\"vfb-field-619\" class=\"vfb-control-label\">Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-619-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-619\" value=\"VISA\">VISA<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-619-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-619\" value=\"MasterCard\">MasterCard<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-619-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-619\" value=\"Discover\">Discover<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-number\" id=\"vfbField620\"><div class=\"vfb-form-group\"><label for=\"vfb-field-620\" class=\"vfb-control-label\">Credit Card Number: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-620\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"number\" name=\"vfb-field-620\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField621\"><div class=\"vfb-form-group\"><label for=\"vfb-field-621\" class=\"vfb-control-label\">Full Name on Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-621\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-621\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField622\"><div class=\"vfb-form-group\"><label for=\"vfb-field-622\" class=\"vfb-control-label\">Credit Card Expiration Date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-622\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-622\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField623\"><div class=\"vfb-form-group\"><label for=\"vfb-field-623\" class=\"vfb-control-label\">Captcha <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6LdWgN0UAAAAAM_hb1SqmzT2DP4J1X289K2epOVA\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField624\"><button id=\"vfb-field-624\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"<p>You may submit a credit card payment for the College program\u00a0in which you are enrolled, or for which you are applying, using this form. You will be automatically sent an email confirming this submission, to the email address that is included in this form, once you have selected the \u201cSubmit\u201d button. We will process this [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":27,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-2147","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2147","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/comments?post=2147"}],"version-history":[{"count":4,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2147\/revisions"}],"predecessor-version":[{"id":14642,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/2147\/revisions\/14642"}],"up":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/27"}],"wp:attachment":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/media?parent=2147"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}