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OnlineHighSchool.org Enrollment Form

Thank you for choosing to enroll with OnlineHighSchool.org. To begin, please enter the information below. Once completed you will receive a confirmation and then be re-directed to the secure payment page. Please enter NA when "Not Applicable"

	Student First Name
	Middle Name
	Last Name
	Address
	City
	State
	ZIP
	Home Phone 777 777-7777
	Email
	Grade:
	Gender:
	Ethnicity:
	Date of Birth
	Learning Accommodations: Note IEP 504 etc
	Primary Guardian First Name if student is less than 18
	Guardian Last Name
	Guardian Phone 777 777-7777
	Guardian Email
	In which courses do you desire to enroll
	When would you like your start date to be
	Other