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Student Name:

Age:

Birthday:

(High school students) Exact name for diploma

Address

Parents Phone Number

Phone Number

Parents Name:

Is the student in any remedial classes?

How did you hear about our school?

Is your student currently in school?

What Grade

Is the student in any AP or Honors classes?

What kind of grades does the student receive in school?

Is the student on grade level in reading and language arts?

Which Subjects

Is the student on grade level in math?

Which Subjects

(High school students) Which math is the student in currently or was completed last year?

Which program are you interested in? Please check one:

Parent is the Teacher Program -- The parent is teaching the child and grading all the work ($975.00 per year for tuition).

Traditional Program -- A teacher in our school will be the teacher and will be grading the work ($2,100 per year for tuition).

Shortened High School Program – For students 17 years old or above ($1,425.00 per year for tuition).