Course Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Phone Number
Work Number
Company
Courses
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
My Products
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Express Package Bronze Bronze Package One time Setup fee of $40 $100 Monthly Subscription- Will be 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. Bronze Package Includes: · Limited Scholarships (4/per week) · Limited Essay edits (4/per week) · The Scholarship Lady's Step by Step Tutorial videos · Free Scholarship Lady workbook · FASFA Assistance · The Scholarship Lady's Newsletter
$ 140.00

Total

$ 0.00
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