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P.A.C.E Program

Student Information

First Name *
Middle Name
Last Name *
Suffix (Jr., Sr., Etc.)
Gender *
Date of Birth *
Ethnicity (optional)
Best Telephone *
Email Address *

Program Information

Please select ONE elective course concentration *

Home & Mailing Address

Home Address Street *
City *
State *
ZIP / Postal Code *
Mailing Address Street *
City *
State *
ZIP / Postal Code *

Terms & Conditions

Scholastic Honor Code
*
Refund Policy
*
Terms and Conditions of Enrollment
*
Student Signature (Type your full legal name):
Parent/Legal Guardian: (If the student is under 18 years of age, a parent or legal guardian must also type their full legal name)
Date

Payment Plan

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