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Enrollment Form
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Email
*
Your email
Full Name of Student
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Grade (Fall 2022)
*
Your answer
Home address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
State
*
Your answer
Cell Phone of Parent
*
Your answer
Home Phone
Your answer
Email of student/email parents will use for the student
*
Your answer
Emergency Contact Name
*
Your answer
Cell Phone of Emergency Contact
Your answer
Emergency Contact's Relationship to student
*
Your answer
Any allergies (peanuts, gluten...)
*
Your answer
Please will you like to pay your tuition online or with a check?
Check (Checks can be sent to Amos Tarfa/LIFE - 1110 14th Street South, Moorhead MN 56560).
Online (email
amostarfa1@gmail.com
to have an invoice sent through email)
Please how will you like to pay your tuition?
Up front Payment for Full Program
Monthly
Other (please email
amostarfa1@gmail.com
if you prefer another option)
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What courses will the student be taking?
*
Elementary School Math (K-6)
PreAlgebra
Algebra 1
Algebra 2
Geometry
PreCalculus
Calculus 1
Calculus 2
French
Spanish
Language Arts (K-6)
Chemistry
Physics
Physical Science
Required
Our students get access to our Teachable site with our Math Courses and other online courses which they can use throughout the year (Please create an account for each student) -
https://learn.fulllifeacademy.org/p/life-stem-academy
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