9c0d381a-e0ab-4503-8978-4ba1c5a2d7bd
DESCRIPTION
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Enrollment Information – Please Print
CURRENT PROGRAM INFO Circle all programs and time frame you want continued access to during the summer.
Reading Assistant i-Ready Reading i-Ready Math Fast ForWord
7 Weeks 7 Weeks 7 Weeks 7 Weeks 3 Weeks-June 3 Weeks-June 3 Weeks-June 3 Weeks-June 3 Weeks-July 3 Weeks-July 3 Weeks-July 3 Weeks-July
STUDENT INFO
LAST NAME: ________________________________ DATE OF BIRTH: ____________________________
FIRST NAME: _______________________________ 2014-2015 GRADE LEVEL: ____________________
MIDDLE NAME: _____________________________ PHONE NUMBER: ___________________________
PERMANENT ADDRESS: _____________________________________________________________________
MAILING ADDRESS: _________________________________________________________________________
PARENT INFO
MOTHER: __________________________________ FATHER: ___________________________________
HOME NUMBER: ____________________________ HOME NUMBER: ____________________________
EMPLOYER: ________________________________ EMPLOYER: ________________________________
WORK NUMBER: ____________________________ WORK NUMBER: ____________________________
CELL NUMBER: _____________________________ CELL NUMBER: _____________________________
EMAIL: _____________________________________ EMAIL: _____________________________________
OFFICE USE: DEPOSIT: _____/_____/_____ BY: ___________ $: __________ CASH / CHECK #: ________
2015 Current, Bridging, Graduating Student
Continued Program Access From Home
PROGRAM INFO 7 WEEKS - Get 1 Week FREE!:
Monday, June 8 - Friday, July 24, 2015
3 WEEKS: Monday, June 8 - Friday, June 26, 2015
Or
Monday, July 6 - Friday, July 24, 2015
COST - 7 WEEKS: $400.00 1 Product
$700.00 2 Products $900.00 3 Products
COST - 3 WEEKS:
$200.00 1 Product $350.00 2 Products
$450.00 3 Products
Payment Due: In Full On or Before June 8, 2015
894 GARY HILLERY DRIVE
WINTER SPRINGS, FL 32708
PH: (407) 366-1099
FX: (407) 366-1909
WHO:
WHAT:
Current Students
Access during the summer months to all
programs that student worked with during the
2014-2015 Academic school year.