Lean Six Sigma Program: No-Interest Payment Plan Request
Thank you for your interest in a No-Interest Payment plan to help manage the cost of attending a Lean Six Sigma Green Belt or Black Belt course with UC San Diego Extension. Please complete this form to initiate your payment plan application. A member of UC San Diego Extension's staff will contact you to finalize your payment plan shortly after submitting this form.

For each program, an initial payment of $495 is needed to secure your spot in the class. The LSS Green Belt and Accelerated Black Belt tuition can be broken into 4 equal payments; the Black Belt program can be broken into 5 equal payments.
Sign in to Google to save your progress. Learn more
Select the program you wish to enroll *
What is the start date of the program you'd like to enroll in *
First and Last Name *
Phone Number *
Email Address *
 Mailing Address (Street, City, State, Zip Code) *
Example: 9500 Gilman Drive, La Jolla, CA, 92093
Select the date you prefer for your recurring payment. *
I understand the initial payment of $495 is due upon submission of the signed payment plan in order to register and ensure my spot in the class. The subsequent payments will begin the month the class begins. *
For example, if you submit your final signed application in January for a class that begins in March, you will make an immediate payment of $495 and then subsequent payments will be due monthly starting in March.  
Upon request from a UCSD Extension staff member, I am willing to provide a credit card to be charged each month until my tuition is paid in full. Credit card information will be provided over the phone. No credit card information will be requested by email. *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy