CEP

	(Part 1 of 2)	PLEASE NOTE: All information must be completed and submitted in less than 10 minutes

Students Last Name

First Name

Parents/Guardians

Home Phone

Grade Entering in Fall

Students Home School

Father Wrk Ph

Father Cell Ph

Mother Wrk Ph

Mother Cell Ph

Mailing Address

City

State

Zip Code

June 7 - June 18 If class is [Full] call for seat availability

Period 1

Period 2

Period 3

Period 4

June 21 - July 2

Period 1

Period 2

Period 3

Period 4

July 12 - July 23

Period 1

Period 2

Period 3

Period 4

Payment will be made by: