Student Registration Form
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Student Name
First Name
Middle Name
Last Name
Birth Date
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Month
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Day
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Year
Gender
Please Select
Male
Female
N/A
Address
Street Address
Street Address Line 2
City
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Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Company
Courses
Please Select
Windows 8
Introduction to Linux
English 101
English 102
Creative Writing 1
Creative writing 2
History 101
History 102
Math 101
Math 102
Additional Comments
Age
Grade
Hobbies
GPA
Height
Ethnicity
What school do you plan to attend?
Are you a parent?
Yes
No
Are you a US citizen?
Yes
No
Are you adopted?
Yes
No
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Express Package Silver
Silver Package One time Setup fee of $40 $140 Monthly Subscription- Will be paid charged to the card on file at the 1st of each month. FAILURE TO PAY WILL RESULT IN CANCELLATION OF MEMBERSHIP. Can start membership back by notifying The Scholarship Lady via email or text. A fee will not be included. Silver Package Includes: · Limited Scholarships (5 @ a time & must complete 4 out of the 5 for more) · Unlimited Essay edits · Monthly 30-minute Zoom call with Scholarship Lady or Rep to go over productivity · The Scholarship Lady's Step by Step Tutorial videos · FASFA Assistance · Free Scholarship Lady workbook · The Scholarship Lady's Newsletter
$
180.00
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