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Student Application Form

* Required fields      
Student Name *:
Street Address *:
City *:
State *:
Zip *:
Date of Birth *:
Gender *:
School Name *:
Grade *:
E-mail Address *:
Home Phone *:
Cell Phone:
Parent/Guardian Name *:
Work Phone *:
Cell Phone:
Enrolling as:
NEC Class Choices:
English
Math
Music
Art
Science

Other (Please specify):

How did you hear about us?

Have you been tutored before? If so, when and where? For which subjects?

What are your educational goals? How can NEC help you achieve them?

Do you have any disabilities or special needs that NEC should recognize?

What are some of your hobbies or interests outside of school?

Other comments?
* Required fields