Application Form

"*" indicates required fields

Student Name*

Responsible Party*

I am the student named above.

I am completing this form on behalf of the student above as their Parent/Guardian.

Parent/Guardian Name*

Contact Information

Phone Number*

Email*

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact

Who should we contact in case of an emergency?

Name*

Relationship to Student*

Phone*

Email*

Demographic Information

We want to remind you that sharing your demographic information is completely optional. The data we collect will only be used for internal analysis to better understand the diversity of our learning community and improve our courses. Your personal information will be kept confidential and will never be shared with outside parties. Your decision to participate or not in this demographic survey will not affect your application or enrollment in any way. Our goal is to create an inclusive and diverse learning environment that meets the needs of all learners. Thank you for helping us achieve this goal.

Student's Gender Identity

Race/Ethnicity

Would you like to Specify your Gender Identity?*

Yes

Gender Identity

Would you like to Specify your Race/Ethnicity?*

Yes

Race Ethnicity

Educational Background

Student's Date Of Birth*

Current School Level*

Desired Enrollment Type*

Desired Start Date*

Name of Your Current School*

School's Location/City*

State or Country*

Expected Graduation Date*

I hereby certify that the information I have provided on this application is accurate, true, and complete to the best of my knowledge.

I authorize my current high school to disclose all academic, and personal information requested by the Office of Admissions at 蘑菇视频.

I authorize 蘑菇视频 to report my academic progress to my high school.

Enrollment decisions are at the sole discretion of 蘑菇视频.

Any enrollment fees are non-refunable once a student Username and ID Number have been issued.

I acknowledge that tution, and fees will continue to be charged on a monthly basis per the 蘑菇视频 Terms of Service.

All payments are due either in full, or by a pre-arranged payment plan, by the last day of each month.

I agree that, in the event of a student's formal withdrawl, I am still financially responsible for all tution and fees due through the month of their withdrawl.

I agree that any cancelation of a pre-arranged payment plan will require immeadiate payment of any and all owed tuition and fees required to keep my account balance current with any monies owed.

Students will have 365 days, starting from their agreed upon Start Date to complete the school year.

Additional time can be requested, and will be considered on a per-case basis.

Contingent upon approval, and subsequent payment of an extension fee, an extension will allow for an additional 60 days of course access.

By signing my name below, I acknowledge, and agree to abide by all policies, rules, and regulations set forth by 蘑菇视频.

Digital Signature*

CAPTCHA

蘑菇视频