CYBER HIGH SCHOOL ENROLLMENT FORM

Thank you for enrolling, you’ll receive a link to complete your registration within 48 hours. If you have any questions, please reach out to us through the contact form.

Student First Name

Last Name

Student Middle Name

Have you ever attended school under a different name? If so, please list it here. If not, please put NA

Age

Birthday

Primary Phone Number

Email

Address

What language did the student first acquire (speak)?

What is the primary language spoken by the student?

What is the primary language spoken at home?

Parent/Guardian Information

(if student is under 18)

Parent Name

Home Phone Number

Phone

Cell Phone Number

Work Phone Number

Email

Other Parent Name

Other Parent Cell Phone Number

Email

Emergency Contact Name

Emergency Contact Name Phone Number

Emergency Contact Email

Educational Information

Add answer here

List Previous Schools, City and State

Last Year Attended High School

Do you have a copy of your transcript?

Have you ever attended an Arizona public school?

Is your student currently enrolled in a Special Education Program? (Optional)

Enrollment

Once you complete enrollment, you will receive a link from our team to complete registration within 48 hours.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

I hereby authorize the release of records to be requested and forwarded to Arizona Prep:

Official Transcript (mail)
Unofficial Transcript (fax or email)
ELL Records/AZELLA Test Scores
Birth Certificate
Special Education Records including IEP, Psychological Reports, etc.
504 Plan

In accordance with the Family Educational Act of 1974 and Arizona State Law, Parent Permission is no longer required when records are requested by authorized school personnel.

State Law 815-828 Paragraph F states that NO SCHOOL SHALL WITHHOLD RECORDS DUE TO FINANCIAL DEBTS.

Arizona Prep is requesting under the prior consent of Student (18) or Parent of minor children to receive their documents regarding academic history for program enrollment and suitability under SB 1303; ARS 15-901.00

Which Program are you interested in?

Online Remote Instruction

Looking for more information or

ready to take the next step and enroll?

Here to assist you 1 (800) 555-1234

- 10AM - 4PM EST

Request Info

Enroll Now

Start your journey to success,

Enroll now with us

Cyber High School is excited to welcome you! Please complete the enrollment form below,