New Credit Recovery Payment Form

Enroll and Pay Credit Recovery Classes Online
Who did you speak with?

Jessicka ChristiP Brianna Yasmin Chandler Other I haven't spoken to anyone
Student you are paying for?
Student Name *

First Name Last Name
Date of Birth *

Month Day Year
Last 4 of Social Security Number
Sex *

Male Female
Last 4 of Social Security Number
Grade Level
Ethnicity
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
What Classes Section (A or B) the student will take for Credit Recovery *
What are you paying for? Tuition, Credit Recovery
Parent Information *

First Name Last Name
What Class(es) are you paying for?
What Class(es) are you paying for?
Parent Email Needed to Monitor Student(s)
Phone Number *

Area Code Phone Number

Which School do you want your classes sent? Name, City and State
Please provide your school information to send your credits.
Name of School *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date School Needs Your Transcript

Month Day Year
Which School do you want your classes sent? Name, City and State
E-mail
Select Which you prefer *

Take Lessons and then Test Review then Test I have reviewed at my school. I am ready to test first.
Please keep in mind, if you fail the exam, you will then take lessons and be able to earn credit once you have made 70% or better.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Upload your Parent ID or Fax to TSA
Parent / Guardian Type Name to Enroll Your Child *

First Name Last Name
Parent/Guardian Type Your first and Last Name to Enroll Your Child/optional signature *
Signature Use Mouse, figure or pen depending on your device

Amount Due *

USD Tuition and Fees .30 + 2.9%

Enroll and Pay Credit Recovery Classes Online