Student Enrollment

Please answer the questions below and click ‘Submit’ to complete the student’s enrollment. If you are enrolling more than one student please submit a separate form for each enrollment.

Parent/Guardian Name*

Parent/Guardian Email Address*

Parent/Guardian Phone Number*

Primary Billing Address*

Parent/Guardian #2 Name (optional)

Parent/Guardian #2 Address (Optional)

Parent/Guardian #2 Email Address (Optional)

Parent #2 Phone Number (Optional)

Student Name*

Student Grade*

Student Birthdate*

What school does the student currently attend?*

School City & State*

Do you authorize Academic Ascent to discuss the student's performance and academic progress with faculty or representatives at the above named school?*

Does the student currently receive supplemental academic support or tutoring elsewhere? *

If you answered ‘yes’ to the above question, please briefly describe the support that is already in place (subject, frequency, etc).

Please provide your payment method. You may change or update this at any time. *

Enter your email above

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