Independent Education Program Interest Form 2025-2026

Independent Education Program Interest Form 2025-2026

We're excited to get to know you! Submitting this form will put you on our email list to receive class and registration information for the 2025-2026 school year. If you are already receiving our emails you DO NOT need to fill out this form. Filling out this from DOES NOT put you on a waiting list or guarantee you a spot in any particular class. Registration is done on a first come, first serve basis after registration opens. Feel free to reach out to us with questions any time at admin@ieprogram.org.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age(s) of the child(ren) for whom you are interested in classes?*
Program(s) in which you are interested?*

Speech and DebateEnglishLeadership and EntrepreneurshipConstitution and Moot CourtRoboticsACT Prep
Which would you prefer?*

In PersonOnlineEither
Anything you want us to know?
Should be Empty: