PACE Enrollment Form
Prepare | Acheive | Create | Evolve
Student Name
*
First Name
Last Name
Age
*
Parent/Caregiver Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What level of support do you feel your child will need to complete tasks?
*
High level of prompting
Moderate level of prompting
Can complete tasks independently
What school does your child attend?
*
Name of school or home school
Enrollment level:
Full-time (Both Tuesday and Thursday for 8-week round) $599
Part-time (Either Tuesday OR Thursday for 8-week round) $400
What goals would you like to see your child achieve out of PACE?
*
How did you hear about PACE?
*
Select
Specify please
School
Friend/Relative
Doctor/therapist/other professional
Social Media
Submit
Should be Empty: