Enrollment

Welcome to your new path towards education and freedom!

Please complete the fields below. If you have any questions do not hesitate to Contact Us.

Student name(required)

Student DOB (must be 12 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(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)

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

⦁