Enrollment

Welcome to your new path towards education and freedom!

All students ages 14+ are eligible to enroll in Symbiosis Learning Center.

All students taking college courses are eligible to enroll in our College Support Program at any time of the year.

All students who have not yet decided if they would like to attend college, need some time to prepare for college, or need a break from college are eligible to enroll in our Gap Year Program.

(Please note that students under 18 require parent/guardian permission.)

Please complete each field below. Once we receive the enrollment information, we will contact you to learn more about you and how we can best support you.

If you have any questions about enrollment, please do not hesitate to Contact Us.

Student name(required)

Student DOB (must be 15 or older)(required)

Student phone number(required)

Student email address(required)

Student address(required)

High School/College/University student is currently, or will be, attending. (If not attending, leave blank)

Please choose the option the student would like to sign up for (leave blank if unsure or if your option is not listed)

Parent(s) or guardian(s) name

Parent(s) or guardian(s) phone number

Parent(s) or guardian(s) email address

Parent(s) or guardian(s) address (if different from student)

Name and contact information of person to contact regarding payment(required)

Please share any additional information that would be helpful, including goals, strengths, dreams, fears, and interests

How did you hear about us?

Name of person that completed this enrollment

Enrollment

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Enrollment

Thank you for enrolling with us!

Thank you for enrolling with us!

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