EIE ACADEMY ENROLLMENT FORM 2010-11
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Family Last Name:
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Father's First Name:
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Marital Status:
____ Married _____ Single ____ Divorced
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Mother's First Name
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Address:
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City
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ZIP
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Home Phone:
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Alternative Phone (i.e. Cell)
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Father's Occupation
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Mother's Occupation
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Children you are enrolling ( Please include first and last name, especially if there are different last names).
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Name
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Birthday
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Place of Birth
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Age
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Grade
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1.
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2.
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3.
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4.
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5.
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Email Address: (This is very important. )
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Why are you homeschooling?
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How long have you homeschooled?
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How long do you want to homeschool?
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We understand that by enrolling our children in EIE Academy that we the parents are the
primary teachers and responsible for the education of our children. We also understand
that EIE Academy will be a source for counseling and activities to help make the home
schooling process a successful one. We also understand that EIE is not an accredited
school and EIE Academy will not seek accreditation in the near future. We do not refund
tuition or fee's after seven days of the enrollment date.
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Father's Signature:
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Mother's Signature
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FEE'S:
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PAYMENT RECORD:
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Tuition
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$310.00
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Total Fees:
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Registration Fee: $20.00 per student
(Maximum of $40.00 per family
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Amount Paid:
Minimum $100.00
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High School Fee:
($40.00 per High School Student)
Maximum $80.00 per family.
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Balance Due
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Payment Plan Fee:*
($50.00 fee if you make payments)
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Method of payment
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Total Fees:
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Date:
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CREDIT CARD INFORMATION:
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NUMBER:
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EXPIRATION DATE:
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SIGNATURE
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IMPORTANT NOTE ABOUT THE PAYMENT PLAN:
We understand that at times it is difficult to make one lump payment, therefore we are providing a payment plan.
To participate in the plan we require the following:
1. A minimum deposit of $100.00.
2. A credit card number so we can make charges on a monthly basis until the balance is paid (maximum of five
payments) or five pre-dated checks that we will deposit on the first of each month.
3. To participate in this program you will be charged a $35.00 fee.
INSTRUCTIONS FOR ENROLLMENT FORM
1. Fill in all pertinent information.
2. When you list your children please be sure to list last name in the case where there is a different last name.
This is very important for us to know all names involved with your family.
3. Please be sure to include your email address.
4. Be sure to sign the enrollment form.
5. Once you have completed the enrollment form please bring it to our Resource Center. We cannot accept
anyone unless we have had the privilege of meeting your family. We do not guarantee acceptance until
we have met you and have determined that this is the best option for your children.
6. If we have already met you and you are mailing your forms in please enclose your payment.
7. Be sure to also enclose the Course of Study for each child, Record Request Form, Teacher Qualification
Form, and Immunization papers (or waiver).
8. Be advised that we do not refund tuition after 7 days from enrollment date. Any refunds up to
seven days of enrollment is for tuition only and does not apply to registration, high school or payment
fees.