Enrollment Please complete the fields below. If you have any questions, do not hesitate to Contact Us. Student name(required) Preferred Pronoun She He They Other (please indicate preference in comments below) Student DOB (required) Student phone number Student email address Student address(required) If first time enrolling, please indicate if student is currently home-schooled or the name of Middle/High School/College/University student is or - in the case of a first-year college student - 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) Alternative to Traditional Middle & High School Full-time Fall 2021 (Mondays - Thursdays) Alternative to Traditional Middle & High School Part-time Fall 2021 College Support Program 1 session/week Fall 2021 College Support Program 2 sessions/week Fall 2021 College Support Program 3 sessions/week Fall 2021 If student is enrolling part-time, please indicate day(s) they will be attending: Parent(s) or guardian(s) name(s) (please list all) 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) How did you hear about us? (If first time enrolling) Name of person that completed this enrollment (if first time enrolling) Additional thoughts, comments, and/or suggestions please include here! Submit Thank you for enrolling with us – We will be in touch soon to hear how we can best support your needs! Share or Print:EmailTweetPrint
