Enrollment Application
A $50.00 application fee is required for background checks.
Name
*
First Name
Last Name
Other names used (e.g. maiden name)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate phone number
Social Secuity Number
Date
*
-
Month
-
Day
Year
Date
Date of birth
*
Emergency contact
*
Name/ Relationship/ Number
Gender
*
Male
Female
Other
Ethnic Background
East Asian or Pacific Islander
Central Asian or Middle Eastern
Black, Non-Hispanic
Hispanic or Latin American
Native American or Alaskan Native
White, Non-Hispanic
Citizenship Status
*
U.S. Citizen
Permanent Resident or Resident Alien (provide Alien Registration Card, form I-551
Refugee or Asylum Status (provide proof of status from USCIS)
Educational Background
*
High School Graduate or GED
Associate Degree or less
Bachelor's Degree
Graduate Degree
Last Highschool Attended
Graduation Date
Which class are you interested in?
*
Hybrid (available starting Dec. 1st)
How do you plan to pay tuition?
*
Pay tuition in full
Deposit + payment plan
Other
Driver's License/ State Identification Card
Browse Files
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Choose a file
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of
Social Secuity Card
Browse Files
Drag and drop files here
Choose a file
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of
I certify that all answers given to questions in this application are correct and complete to the best of my knowledge. I understand that failure to answer questions honestly may result in denial of application.
*
My Products
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Application Fee
Application fee is non-refundable and will be applied towards background check.
$50.00
$
50.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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