Individual Class(es) Payment Form 2017/18

Enroll and Pay Individual Classes Online
Student Name *

First Name Last Name
Date of Birth *

/ Month / Day Year
Last 4 of Social Security *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
E-mail
Have you taken the prerequist for this class?

Yes No
What Classes will your be taking and the Section (A or B) *
Parent Information *

First Name Last Name
Parent E-mail *
Phone Number *

- Area Code Phone Number

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	Country

Date School Needs Your Transcript

- Month - Day Year

Pay for your Individual Class(es) Below:

Registration is $100.00 plus your tuition.

Summer School Tuition is Paid at time of Enrollment

Individual Class Fees

1/2 Credit (or 2 Quarters Hrs) = 0.50 (1/2 credit) $150.00

1 Credit (or 4 Quarters Hrs) = 1.00 Credit $300.00
Parent / Guardian Type Name to Enroll Your Child *

First Name Last Name
Upload your Parent Phot ID or Fax to TSA
Enter Total amount: *

Amount Due *

USD Tuition and Fees .30 + 2.9%

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Amount Charged
Should be Empty: