Re-Enrollment Application

1
Parent Name / Admitting Adult* This field is required.
2
Cell Phone Number* This field is required.We have texting capabilities.
3
Email* This field is required.We send information, receipts, and correspondence to this email address.
me@home.com
4
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Add a 2nd Adult?* This field is required.Any other adult that may be assisting the student with assignments.
YESNO
6
2nd Adult Information
Name (First and Last Name please)
Email Address
Cell Phone Number
Please Select
Please Select
Parent
Step Parent
Tutor
Sibling
Aunt / Uncle
Grandparent
Other
Relationship to student
7
I'm enrolling _______ kids.* This field is required.
1
2
3
4
5
6
8
Student 1 Information* This field is required.Start with the OLDEST student.
Full Name
Please Select
Please Select
Female (Girl)
Male (Boy)
Gender
Date of Birth
Age
Please Select
Please Select
Online Program (3rd-12th Grade)
Combo Program (3rd-6th Grade)
Print Based Program (K-3rd Grade)
Program Choice
Please Select
Please Select
No, thank you
Pay as You Go - $30 per 30 min session
1 session per week - $100 p/mon
2 sessions per week - $200 p/mon
TUTOR-on-CALL (Available to Online or Combo Program only)
9
Student 2 Information
Full Name
Please Select
Please Select
Female (Girl)
Male (Boy)
Gender
Date of Birth
Age
Please Select
Please Select
Online Program (3rd-12th Grade)
Combo Program (3rd-6th Grade)
Print Based Program (K-3rd Grade)
Program Choice
Please Select
Please Select
No, thank you
Pay as You Go - $30 per 30 min session
1 session per week - $100 p/mon
2 sessions per week - $200 p/mon
TUTOR-on-CALL (Available to Online or Combo Program only)
10
Student 3 Information
Full Name
Please Select
Please Select
Female (Girl)
Male (Boy)
Gender
Date of Birth
Age
Please Select
Please Select
Online Program (3rd-12th Grade)
Combo Program (3rd-6th Grade)
Print Based Program (K-3rd Grade)
Program Choice
Please Select
Please Select
No, thank you
Pay as You Go - $30 per 30 min session
1 session per week - $100 p/mon
2 sessions per week - $200 p/mon
TUTOR-on-CALL (Available for Online or Combo Program only)
11
Student 4 Information
Full Name
Please Select
Please Select
Female (Girl)
Male (Boy)
Gender
Date of Birth
Age
Please Select
Please Select
Online Program (3rd-12th Grade)
Combo Program (3rd-6th Grade)
Print Based Program (K-3rd Grade)
Program Choice
Please Select
Please Select
No, thank you
Pay as You Go - $30 per 30 min session
1 session per week - $100 p/mon
2 sessions per week - $200 p/mon
TUTOR-on-CALL (Available for Online or Combo Program only)
12
Student 5 Information
Full Name
Please Select
Please Select
Female (Girl)
Male (Boy)
Gender
Date of Birth
Age
Please Select
Please Select
Online Program (3rd-12th Grade)
Combo Program (3rd-6th Grade)
Print Based Program (K-3rd Grade)
Program Choice
Please Select
Please Select
No, thank you
Pay as You Go - $30 per 30 min session
1 session per week - $100 p/mon
2 sessions per week - $200 p/mon
TUTOR-on-CALL (Available for Online or Combo Program only)
13
Student 6 Information
Full Name
Please Select
Please Select
Female (Girl)
Male (Boy)
Gender
Date of Birth
Age
Please Select
Please Select
Online Program (3rd-12th Grade)
Combo Program (3rd-6th Grade)
Print Based Program (K-3rd Grade)
Program Choice
Please Select
Please Select
No, thank you
Pay as You Go - $30 per 30 min session
1 session per week - $100 p/mon
2 sessions per week - $200 p/mon
TUTOR-on-CALL (Available for Online or Combo Program only)
14
Tuition Plan payment preference:* This field is required.
Full Year up front
Monthly - Auto Pay
15
Please process my Registration Payment in:* This field is required.Choose day in next box.
April
May
June
July
August (late)
16
I prefer my Registration to be processed on:
1st
5th
17
I prefer my Registration to be processed on:* This field is required.Choose a day for us to process payment.
1
5
10
15
20
25
18
The 1st, 5th, and 10th of the month as the best payment days for the tuition plans. BUT if you wish to have the payment day after the 10th, please start your tuition payments in JULY.

For those in the Print Based Program, wanting any day after the 5th of the month, will also need to start tuition in JULY. This will ensure no delay in shipments of needed materials and receipt of books before you need them.

If you have questions, please call or text the office.
19
Please process my 1st Tuition payment in:* This field is required.Or FULL YEAR tuition (if chosen). Choose day in next box.
July
August
20
July Tuition On :Choose a day for us to process payment.
1
5
10
15
20
25
21
August Tuition On :Choose a day for us to process payment.
1
5
22
I prefer my remaining Tuition payments to be on the ____ of each month.* This field is required.
1st
5th
10th
other: (requires permission)
23
Please note financial policy - Online student portal is disabled if obligation is overdue by 30 days and until funds towards the balance is received.
24
I prefer Late Assignment Fees to be processed ...* This field is required.Incidental fee due only if a student misses a Deadline Review Date.
Automatically (best)
Email an Invoice
25
Use the same card as last year?
Yes, thank you!
No, I have a new one.
26
Card Verification* This field is required.
Please Select
Please Select
Visa
MasterCard
Discover
Card Type
Last 4 digits on the card
27
Enrollment Terms and Agreement* This field is required.A hardcopy will be included in the emailed copy once submitted.
28
Please verify that you are human* This field is required.
29
Signature
Should be Empty: