Individual Class(es) Payment Form 2018/19

Enroll and Pay Individual Classes Online
Student Name *

First Name Last Name
Date of Birth *

Month Day Year Date Picker Icon
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 Date Picker Icon

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
Card Expiration

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

Amount Charged
Should be Empty: