Application Form for Student Demographics & Program Selection

Student's Name*

Student's Last name*

Your email

Gender*

What Program are you applying for?*

Workbook Program

ePACE

Online program-Maximum reached. Availability will be made known, when slots are open again.

What grade are you applying for?*

K- 5th

6th-8th

9th-12th

Specify Grade *

Indicate last grade completed *

Current Address*

City State and Zip-Code*

Date and Year of Birth*

Parent/Legal guardian's information*

Parent/Legal Guardian's Phone Number*

Parent/Legal Guardian's Email*

Immunization information

For religious reasons my child is not immunized.

For personal conviction my child is not immunized.

My child is fully immunized

My child is not fully immunized

Digital Signature of Parent /Legal Guardian*

If referred by an employee, please include their name , to get a waiver of $110 enrollment fee/Otherwise type NA

Any other important information/ Otherwise type NA

Students enrolled in Workbook or ePACES, can join Zoom classes every morning, to get help from qualified supervisors. No commitment. Please indicate if you are interested at no extra cost to you. By clicking yes, you agree to all policies, terms and procedures.

Yes- Enroll my student for Zoom classes

Undecided at this time.