Application Form
※Please complete all information in ENGLISH
Student Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level
*
School Last Attended
*
Parent/Guardian's Information
Parent/Guardian's Name - Primary
*
First Name
Middle Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Parent/Guardian's Name - Secondary
First Name
Middle Name
Last Name
Phone Number
-
Area Code
Phone Number
Program Applied for
*
Mission Command
Supernova
Other
Photo Copy of Birth Certificate
※
Upload
*
Original Report Card
Most recent report card duly signed by the school head. The report card should clearly indicate the grade level completed and certify eligibility for admission or transfer.
Upload
Transcript/School Records
Upload
ID Picture
Digital copy of the child’s latest photo (taken within 3 months, with a white background)
Upload
*
Terms and Conditions
*
Date Signed
*
-
Month
-
Day
Year
Date
Parent/Guardian Signature
*
Referral Code
Reminders
REQUIREMENTS. It is important to pass and complete all requirements before school starts. Failure to do so may delay the student from beginning the program. If you have any questions or concerns about filling out the application form, please don’t hesitate to contact us at support@homeschool-universe.com.
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