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Application for Enrollment

This application is for admission to a program of study at Charter College. Upon submitting this form, you will be contacted by a Charter College associate to answer any questions you may have and continue the application process

* = required fields
First Name:*
      
 		 Work Telephone Number:
 
Last Name:*
      
 		 Home Telephone Number:
 
Email:*
      
 		 Cellular Telephone Number:
 
Address 1:*
      
 		 Number where you may be reached now:*
  

Address 2:
      
 
City:*
        
 		 State:*
      
Zip Code:*
      
 		  
Gender:
      Male Female 		Date of Birth:*
 
Which Program interests you?:* (you may select more than one)

 
 
Are you a current Student?:

Yes  No
 
Year of High School Graduation or GED*
High School Name
Campus you would like to attend*
Please enter any Questions below:

 
 

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