iPad Reservation/Payment Form 2025

iPad Reservation/Payment Form
Student Name*

First NameLast Name
Phone Number*
Email*
example@example.com
Campus*
Brooklyn Programs*
Staten Island Programs*
Please choose a Program:*

RadiographySonography - Abdomen/OBSonography - Echo/VascParamedicRadiation TherapySurgical TechnologyMedical Dosimetry
In order for students to receive a CAHE-administered iPad at Orientation the iPad Reservation/Payment Form must be completed. All students are required to utilize the CAHE-administered iPad for testing, classes, and assignments, while enrolled in the program. This is the case regardless of if they have their own devices. The iPad will come fully equipped with all necessary software. CAHE assumes no responsibility for any loss, theft, or damage to a student issued iPad and the student must purchase a replacement if this situation arises.
I would like to order scrub skirts instead of scrub pants.*

YesNoBoth( Must specify quantity of each by Special Requests)
4 - Scrub Tops*
1 - Scrub Tops*
5 - Scrub Tops*
4 - Scrub Pants*
1 - Scrub Pants*
5 - Scrub Pants*
Skirts*
1 - Short Lab Coat*
1 - Long Lab Coat*
2 - Short Polo Shirt*
2 - Long Polo Shirt*
1 - Sweatshirt*
Please choose a sweatshirt color*
I understand that I will receive the order that I have placed above. There will be no refunds, no exchanges once the uniform order has been submitted.

Payment*

iPad Payment$365.00

Subtotal $0.00Tax $0.00Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

I understand that the payment for the iPad is non-refundable once I receive an school issued iPad at Orientation.
Signature:*

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