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Parent/Guardian Name
*
First
Last
Parent/Guardian Phone Number
*
Parent/Guardian Email Address
*
Phone Number Discounted
Student Name
*
First
Last
Date of Birth
*
Current Grade School Name & State
*
Current grade level
*
Please Select Grade in Dropdown
7th grade
8th grade
9th grade
10th grade
11th grade
12th grade
Recent graduate
Expected Graduation Year
*
Desired Start Date
*
Is student enrolling with a friend? If yes, please provide full name of friend.
Parental/Gaurdian Consent Statement
*
I understand and accept the terms of this consent
By submitting this enrollment application, I give permission for my child to participate in this online course. I understand that the course will involve internet use, including exploring college websites and educational resources. I acknowledge that it is my responsibility to monitor my child’s online activity and ensure their appropriate use of the internet throughout the duration of the course. I understand and accept the terms of this consent.
Please Select Only One Item: Discounted Rate only applies when enrolling with a friend
Student Tuition –
$300.00
Student Tuition “Discounted Rate” –
$250.00
Add ons –
$50.00
Credit Card
*
Submit