Payments - GPA 2s/3s Program SEAT SAVER

2025-2026 GPA 2s/3s Program SEAT SAVER
Student Name

First NameLast Name
Student Date of Birth
Parent Name

First NameLast Name
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent Email
example@example.com
By signing below, I First Name Last Name agree, that I am a parent or legal guardian of the student named below and that I will provide a payment to GPA PMA Via Zelle: 516-835-9817, davidmachson1@gmail.com in the amount of $250 as a deposit towards the 2025-26 Academic year. The deposit is refundable if GPA determines that a child needs services that are not provided by GPA. It is non-refundable for any other reason unless there is an emergency situation which must be reviewed by the advisory board. This will require an email to the advisory board: GPAAdvisory@protonmail.com
Signature of Parent/Legal Guardian
Date

MonthDayYear
Date
Should be Empty:

2025-2026 GPA 2s/3s Program SEAT SAVER