Application Form

Application Form

※Please complete all information in ENGLISH
Student Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Level*
School Last Attended*
Parent/Guardian's Information
Parent/Guardian's Name - Primary*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
Parent/Guardian's Name - Secondary

First NameMiddle NameLast Name
Phone Number

Area CodePhone Number
Program Applied for
Mission CommandSupernova
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*

MonthDayYear
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.
Should be Empty:

Parent/Guardian's Information