Student Information

Completing the OPEN Enrollment Form

Title

First Name

Last Name

Email Address

Course Selection

Street Address

Address City

Address State

Address Zip

Home Phone Number

Cell Phone Number

Work Phone Number

🔒 Social Security (required for reporting purposes only)

Employed

Date of Birth

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Terms and Conditions

⚠️ Please read the document below. If you agree to the Terms and Conditions listed, please click the "Agree to Terms" button in the bottom right corner.
The form will automatically be filled in based on the information you provided on the previous page.

Intellectual Point

Completing the OPEN Enrollment Form

Student Information

Completing the OPEN Enrollment Form

Terms and Conditions

Completing the
OPEN Enrollment Form