Student Name* First Last Are you currently enrolled in one of our partnering Michigan school districts?* Yes No Partner school*--please select one--Buchanan Community SchoolsBurr Oak Community SchoolsClimax-Scotts Community SchoolsClintondale Community SchoolsDeckerville Community SchoolsDeWitt Public SchoolsGobles Public School DistrictHarper Woods School DistrictHuron AcademyMancelona Public SchoolsMattawan Consolidated SchoolsNew Haven Community SchoolsOak Park SchoolsParchment School DistrictRiver Rouge School DistrictSt. Johns Public SchoolsVandercook Lake Public SchoolsWestwood Heights Community SchoolsGender* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student Phone Number*Secondary Phone Number for StudentStudent Email Address* ZIP Code for Student* Parent/Guardian Name* First Last Parent/Guardian Phone Number*Parent/Guardian Email Address* Secondary Phone Number for Parent/GuardianApplicants will be contacted to provide additional detailed forms for enrollment. We will also need parent and or student ID, proof of residency, verification of their original birth certificate, immunization records, and school transcripts.HiddenIs the Student 18 years or older? Yes No Consent By checking the box and clicking SUBMIT below, you agree that we may call and/or text you at the number you entered above with reminders, offers and other info, including possibly using automated technology, text and recorded messages. Consent is not a condition of purchase. Reply STOP to opt out of text messaging. Standard rates apply. Security CheckEmailThis field is for validation purposes and should be left unchanged. Unfortunately your age does not meet the requirements for this program. We do have another program more appropriate for you. Please fill out this form to start your enrollment process.
