EIE ACADEMY  ENROLLMENT FORM  
Family Last Name: Father’s First Name:
Marital Status:
____ Married  _____ Single ____ Divorced		 Mother’s First Name
Address:                                                                                                        City:                                              State: ZIP
Home Phone: Cell Phone:
Father’s Occupation Mother’s Occupation
Children you are enrolling ( Please include first and last name, especially if there are different last names).
Name Birthday Place of Birth Age Grade
1.
2.
3.
4.
5.
Email Address:  (This is very important. )
Why are you homeschooling?

 

 
How long have you homeschooled? How long do you want to homeschool?

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.
Father’s Signature: Mother’s Signature
FEE’S: PAYMENT RECORD:
Tuition $350.00 Total Fees:
Registration Fee:  $20.00 per student
(Maximum of $40.00 per family		 Amount Paid:
Minimum $100.00
High School Fee:
($40.00 per High School Student)
Maximum $80.00 per family.		 Balance Due
Payment Plan Fee:*
($50.00 fee if you make payments)		 Method of payment
Total Fees: Date:
CREDIT CARD INFORMATION:  

NUMBER:______________________________________________________________________
EXPIRATION DATE:________________

 CVV CODE:______________________

 SIGNATURE ____________________________________________________________________

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 $50.00 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.