| Christian Educators Enrollment Form(one form per student) |
| STUDENT'S INFORMATION |
Enrollment Type
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First Name
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Middle Name
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Last Name
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Address
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City
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State
Zip Code
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| Home Phone with area code
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Email Address
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| Date of Birth (mm/dd/yyyy)
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Grade
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Social Security Number
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| Has student ever homeschooled before?
Yes
No |
Curriculum used:
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Has student ever been "held back" or had to repeat a grade?
Yes
No |
Curriculum Option
(you specify)
B (we recommend) |
Registration/TuitionFee
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Diploma Choice (Highschool only)
I = Honors, II = Standard, III = Vocational |
How did you hear about us?
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| PARENT'S INFORMATION |
| Father's First Name
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Father's Last Name
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Daytime Phone
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Father's Place of Employment
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Brief Educational Background
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| Mother's First Name
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Mother's Last Name
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Daytime Phone
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Mother's Place of Employment
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Brief Educational Background
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| Copyright © 2004 Christian Educators |
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| * Please review the form and make sure all fields are filled before you click the "Submit" Button |
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