EIE Enrollment Form

Father's Name *

First

Last

Mother's Married Name *

First

Last

Address

City *

State *

ZIP

Home Phone Number *

Cell Phone Number *

E-Mail Adddress *

Father's Occupation

Mother's Occupation

Marital Status

Children you are enrolling.

First Name

Last Name

Birthday

Grade

First Name

Last Name

Birthday

Grade

First Name

Last Name

Birthday

Grade

First Name

Last Name

Birthday

Grade

First Name

Last Name

Birthday

Grade

Why are you homeschooling?

Why do you want to join EIE Academy?

How long have you been homeschooling?

How long do you want to homeschool?

Are you a member of HSLDA, if so your number?

Father's Signature

Mother's Signature

Tuition:

Cash Payment: Can only be made at EIE

New Student Fee: $20.00 per student, $40.00 family maximum

Check Number

High School Fee: $40.00 per high school student, maximum $80.00

Total Amount Due

PayPal *

To submit enrollment on line:

To mail in enrollment:

Credit Card Number

Expiration Date

CCV (Security Number)

Mailing Address