Ree Birthing A Star
Adult High School Diploma Program (6 weeks)
Student Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Student Email
example@example.com
Student Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Grade Level Last Finished
Name Of Last School Attended
Student Hobbies / Current Occupation
What subjects do you feel the strongest in ?
Program Fee: $25 to enter Google Classroom (more is accepted) Testing Fee: $50 (minimum donation)How will you make your payment/donation?☐ Online www.reebirth.us☐ CashApp / PayPal / Zelle☐ In-personWould you like to donate more to help support another student? (Yes / No)
Do you have any learning challenges or disabilities we should be aware of?
Why do you want to earn your high school diploma?
Official or unofficial transcripts :
Browse Files
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Choose a file
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Upload the picture of the student here
Browse Files
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Choose a file
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Virtual Equipment Checklist
Available
Not Available
Will Purchase
Desktop PC
Laptop
Tablet
Phone
Emergency Contact Information
Name
First Name
Last Name
Relationship
(Father, Mother, Guardian, etc.)
Phone Number
Please enter a valid phone number.
Coaching partner in case help is needed
First Name
Last Name
Relationship
(Father, Mother, Guardian, etc.)
Phone Number
Please enter a valid phone number.
Acknowledgment
I acknowledge that I will be participating in a virtual or distance learning.
I confirm that I will attend the online school with integrity.
I confirm that I will be responsible for providing the equipment needed for virtual learning.
I accept that all activities, works, and exams will be graded.
I have 6 weeks to complete all online work and pay for my exam, before I am removed from the class.
Date Signed
-
Month
-
Day
Year
Date
Signature
Apply
Apply
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