Companion Course Registration Form

Student Information

Student First Name 

Student Last Name

High School Email Address

Personal Email Address

Parent/Guardian Email Address

Which email is your current Canvas account connected to?

Please select... High School Email Personal Email

UDID

This is a nine character number starting with 702.

If you do not have a UDID, apply for one here.

School Information

Where is your school located?

Please select... California Colorado Connecticut Maine Maryland New York Pennsylvania Rhode Island International

What Maryland school do you currently attend?

Please select... Saints Peter & Paul High School West Nottingham Academy

What Connecticut school do you currently attend?

Please select... Marvelwood

What New York school do you currently attend?

Please select... Bedford Academy High School Blind Brook High School Brooklyn Academy of Global Finance Cypress Hills Collegiate Preparatory School Eagle Academy III Innovation Charter High School James Madison High School Midwood High School New Dorp High School New World High School Preston High School The Masters School United Charter High School for Advanced Math and Science Xaverian High School

What Pennsylvania school do you currently attend?

Please select... Bishop Shanahan High School Devon Preparatory School Downingtown STEM Academy Gwyenedd Mercy Academy High School Interboro High School Kennett High School Linden Hall School For Girls Malvern Preparatory School Manheim Central High School Merion Mercy Academy Oxford Area High School Penncrest High School Perkiomen School Plymouth Whitemarsh High School Sacred Heart Academy Bryn Mawr Sun Valley High School

What Rhode Island school do you currently attend?

Please select... East Greenwich High School La Salle Academy

What Maine school do you currently attend?

Please select... Hyde School

What California school do you currently attend?

Please select... Dunn School

What Colorado school do you currently attend?

Please select... Dawson School Colorado Academy

What International school do you currently attend?

Please select... American Cooperative School Calvert American Embassy School American International School of Budapest International School of Kenya International School of Panama Santa Cruz Cooperative School The International School of Nido de Aguilas

Which course(s) would you like to register for at this time?

EntreX (Form)LeadX (Form)EntreX and LeadX (Form)

Which course(s) would you like to register for at this time?

EntreX (Form)LeadX (Form)DesignX (Form)EntreX and LeadX (Form)LeadX and DesignX (Form)EntreX and DesignX (Form)EntreX, LeadX and DesignX (Form)

Demographic Information

How would you describe your gender?

Please select... Female Male Other Prefer not to say

Which selection best describes you?

Please select... American Indian or Alaskan Native Asian Black/African American Caucasian/White Hispanic/Latino Native Hawaiian or Other Pacific Islander Multi Racial

Course Registration

Upload your Course Registration document below.

To obtain a course registration form, download one here.

Scholarship Information

Do you believe you qualify for a need-based scholarship? Qualifying students typically come from households receiving other forms of state or federal assistance such as free or reduced meals at school, SNAP benefits, or Medicaid.

Please select... Yes No

Based on the information below, please select the scholarship level you qualify for.

Scholarship Level 1Scholarship Level 2

Scholarship Confirmation

By typing your name below, you certify that the information provided above is accurate to the best of your knowledge at the time of submission. 

Hidden Fields

EntreX

EntreX

LeadX

LeadX

Qualify for scholarship

TRUE

CEP Eligible

Level 2

School covering tuition

TRUE

EntreX/LeadX Combo

TRUE