CPM New Student Inquiry Form

CPM New Student Inquiry Form

College Path Mentorship New Student Inquiry Form
The following form is for pre-registration. We will then hold an orientation meeting where attendance is mandatory to be admitted to the program. If you are interested in enrolling or learning more about the program, please fill out the form below, and someone will contact you as soon as possible. If you have questions, please contact us at info@uplift.academy. Visit our webpage for more information at https://uplift.academy/CPM/

Venue: Masjid Abu Bakr - 300-306 Preakness Ave. Paterson, NJ 07502

Contact: MD Forid Uddin / Burhan Uddin

Email: foridnjcu@gmail.com / ruhel917@gmail.com

Phone: 973-582-8195 / 908-391-5090
Student Full Name*

First NameLast Name
Student Birthday*

MonthDayYear
Date
School Name*
Student's current grade*

10th11th
GPA*
Student Phone Number*
Student E-mail*
example@example.com
Which city do you live in?*
Parent Full Name*

First NameLast Name
Parent Phone Number*
Parent E-mail*
example@example.com
How did you hear about us?*
Should be Empty: