AJ Tutoring Student Enrollment

Term*

Please Select Term from the drop down menu below

Course Title*

Please refer to the Course Schedule page on our website for course title, time/period and availability.

Time or Class Period*

For summer classes, please specify the time and for Spring or Fall classes choose the class period.

Student Name (as appears on transcripts)*

First Last

Student's Date of Birth*

Year of Graduation*

Student's Current Grade Level*

Parent or Guardian Name*

First Last

Mailing Address*

Street Address City ZIP Code

Parent Cell*

Student's school to receive transcript*

Student's guidance counselor/registrar's email to send transcript

Parent Email to receive progress reports*

Student email*

How did you hear about us?*

We would like to thank the person who referred you to HBA so please type their name below.

Emergency Contact Name (other than self)*

First Last

Emergency Contact Phone (other than self)*

Credits*

Authorization*

Please click here to read the full text of our Enrollment Agreement. Please acknowledge that you are aware of the following policies by checking all boxes below:

Is there any information you would like to share with us?

Reason for taking the course*

Please indicate whether the student is repeating this course to remediate a low or failing grade or is taking it for the first time.

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AJ Tutoring Student Enrollment Form (1)