Your E-mail address

Name of student
Student's date of birth
*Current grade level 1 2 3 4 5 6 7 8 9 10 11 12
*Name of last school attended
Full Address of last school attended
*Phone number of last school attended
*Do you want cumulative records transferred from previous school? Yes No
*Name of mother
*Name of father
Address
City
State
Zip Code
Telephone

* required for K-12 Students Only

Curriculum Materials Ordered

Landmark Bible-Based Curriculum Set (Select Grade Level 1st-12th) $150 none 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
Kindergarten Program $50

High School Electives $50 each:
Bible I
Bible II
Bible III
Bible IV
Home Economics
Shop
Computer Literacy
Personal Development (for young ladies only)

Enrollment Fee is $25 and must be added to your total

Tuition $150.00 1st Quarter Tuition
1st quarter - $150


Adult Diploma Program $500

For students 9th grade and above, please list classes already taken. For adult students, please list name as you wish for it to appear on diploma.

If mailing form, please sign and date below. Also, for students in grades 9 and above,
please attach a copy of your transcript or a list of classes taken.

Signature _________________________________ Date: __________

Any questions, please send to info@highlandheightsacademy.com