Part-time Registration Form

STUDENT INFORMATION:

Full Legal Name (required)

Date of Birth (required)

Male or Female (required)
---MaleFemale

Current Grade Level (required)

Enter number of either semester or full-year courses desired, then name/title of course desired:

Number of Semester Courses

Semester Course Title(s)

Number of Full-year 2 Semester Courses

Full-year 2 Semester Course Titles(s)

Enter information about the school where the credit will be transferred. If homeschool, enter name of your homeschool.

School to Receive Credits (required)

School's City (required)

School's State (required)

PARENT INFORMATION:

Parent Name or Names (required)

Mailing Address (required)

Street Address

City (required)

State (required)

Zip (required)

County (required)

Email- primary not junk account (required)

Home Telephone (required)

Cell Phone

START DATE AND SIGNATURE:

Date Desired To Start School Work

By entering my name in the Signature box(es), I verify the information entered is correct.

Parent Signature (required)

Signature Date (required)

The next screen will allow you to pay your course fee(s) online or fill out a form to notify us when you will call in your payment. The course fee(s) is required to finalize registration. Thank you!

If error message when submitting, look for any uncompleted questions above and resubmit again.