MCS Registration Form

MCS Registration Form
STUDENT INFORMATION

First NameLast Name
Date of Birth

MonthDayYear
Date
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last School Attended, City and State or Country
Email
example@example.com
Phone Number
Please enter a valid phone number.
PARENT INFORMATION First Name Last Name Email Area Code Area Code Phone Number
Program of Interest
Payment Options

Credit Recovery (3 month term) $950.00Home School (w/Testing) $1050.00In School (3 month term) $2750.00Application Fee $100.00Technology Fee $390.00Transcript Fee $50.00Express Mailing $40.00Verifications $70.00Graduation Ceremony $350.00
I will be making a payment for in the amount of
I understand I have 3 months to complete this agreement/Contract Unless stated by the director in writing. APPLICATION & TECHNOLOGY FEE MUST BE PAID BEFORE ENTERING THE PROGRAM.
No refunds after 14 days of submitting application & technology payment or receiving course materials.
**Please make payment arrangements with the school's Director**
Should be Empty: