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Student Information
Student Contact Information
First Name* 
Last Name* 
Date Of Birth* 
Home Phone* 
Student Phone Number  
Mailing Address* 
Country* 
State* 
City* 
Zip* 
Email Address
Gender* 
Ethnicity* 
Parent/Guardian Information
Parent/Guardian A - Contact Information
First Name*
Last Name*
Home Phone*
Cell Phone 
Mailing Address (if different) 
Country 
State 
City 
Zip 
Email Address*  
Parent/Guardian B - Contact Information
First Name 
Last Name 
Relationship 
Email Address  
Phone Number
STUDENT ACADEMIC INFORMATION
Grade Level* 
Additional Notes 
Name of Partner School Attended (if applicable)
How did you hear about us* 
Please select program of interest* 
Upload Academic Documents
Upload Documentation of Legal Name and Birthdate
(Examples of acceptable uploads include: Birth Certificate, Passport, Drivers license. If documents are in a language other than English, please upload English translations as well as original documents.)
  I am an ESL Student. (English is not my first language)
  Check here if interested in taking an academic assessment to see if your student is ahead or behind. (Additional fee of $99 applies)