Dual Registration - Sara Schenirer Institute

Sara Schenirer Dual Credit Pre-Registration

PLEASE NOTE THAT COMPLETING THIS FORM REGISTERS YOU WITH OUR PROGRAM, ENABLING YOU TO SIGN UP FOR CLASSES IN SEPTEMBER.

THIS REGISTRATION DOES NOT ENROLL YOU IN SPECIFIC CLASSES. YOU WILL NEED TO CHOOSE YOUR CLASSES AND ENROLL IN SEPTEMBER.

IF YOU FAIL TO ENROLL IN SEPTEMBER, YOU WILL NOT RECEIVE CREDITS.

"*" indicates required fields

Legal Name*

First Middle Last

Date of Birth*

SSN*

Gender*

Current High School*

Current Grade*

Mobile Number*

Home Number*

Email*

Alternate Email

Permanent Address*

Street Address Address Line 2 City State ZIP Code

Parent/ Legal Guardian Phone Number*

Parent/ Legal Guardian Email*

CAPTCHA