Application Form

Please fill out this form and a admissions counselor will contact you as soon as possible.

Parent First Name *
Parent Last Name *
Address *
Address 2
City *
State/province *
ZIP Code *
Email Address *
Phone Number *
Please select which courses you are interested in. (Maximum 5 Courses) Bold Classes are self driven and can be taken at anytime at your own pace.
Core Classes	English 9A English 9B English 10A English 10B English 11A English 11B English 12A English 12B U.S. History Pre-Algebra Algebra Algebra II Geometry Biology Earth Science Physics Computer Applications World Civilization Government Economics
Electives	Modern fiction Cinema review Bowling Weight lifting Music appreciation
Student First Name *
Student Last Name *
Student Grade Level
Number of Credits Completed (if known)
School Name
School City and State
School Phone Number
Do you have a high speed internet connection?	Yes No
Do you have a USB webcam for your computer?	Yes No
Do you have a USB headset for your computer?	Yes No
If any of the last 3 answers are no are you willing to have this equipment available for the first day of classes?	Yes No
Are you interested in 1 on 1 tutoring for your student for an additional $15.00 per hour?	Yes No