If you would like to take our online courses but do not have a username and password, please complete the enrollment form below. Student Information First Name:* Middle Name: Student's Last Name:* Student’s Address:* City:* State/Province:* Zip Code:* Date of Birth:* Current Grade:* 789101112 Gender:* MaleFemale Home Phone #: Cell Phone #:* E-mail address:* Mother/Guardian Information Mother's First Name: Mother's Last Name: Mother’s Address: City: State/Province: Zip Code: Home Phone #: Cell Phone #: E-mail address: Father/Guardian Information Father's First Name: Father's Last Name: Father’s Address: City: State/Province: Zip Code: Home Phone #: Cell Phone #: E-mail address: Current School Information School Name:* School’s Address: City:* State/Province:* Zip Code: School Phone #: Fax #: Counselor/Advisor Name: Previous School Information School Name: School’s Address: City: State/Province: Zip Code: School Phone #: Fax #: Counselor/Advisor Name: Previous School Information School Name: School’s Address: City: State/Province: Zip Code: School Phone #: Fax #: Counselor/Advisor Name: Academic Goals My academic plan is to: Graduate through Excelsior SchoolTransfer credits to my current schoolI'm not sure My post high school plans are: College/UniversityWorkforceMilitary Do you have an Individualized Education Plan? Yes (if yes, then please attach)No other Input this code:* By submitting this enrollment form you are agreeing to abide by the Terms and Conditions of enrollment agreement.