Student Information
Student Contact Information
First Name* 
Last Name* 
Date Of Birth* 
Home Phone* 
Student Phone Number  
Mailing Address* 
Country* 
State* 
City* 
Zip* 
Gender* 
Ethnicity* 
Email Address*
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
Grade Level* 
Additional Notes – Tell us about your student
Name of Partner School Attended (if applicable)
How did you hear about us* 
Please select program of interest* 
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.)
  Check here if interested in taking an academic assessment to see if your student is ahead or behind. (Additional fee of $99 applies)