Personal Information

Full-Time or Part-Time?*
Course interested in:*
First Name:*
Last Name:*
Preferred Pronouns:*
Address:*
City:*
Province:*
Postal Code:*
Home Phone:
Cell Phone:*
Email:*

Emergency Contact

Name:*
Phone:*
Address:*

Education

SECONDARY SCHOOL

High School Name:*
Current Grade:*
Graduation Year:*

POST-SECONDARY SCHOOL

Post-Secondary School Name:
Program:
Current Status:
Graduation Year:

The following information is necessary for security purposes to verify your identity in the future if you request a transcript or diploma receipt.

Your Date of Birth:
Your Mother's Maiden Name:*
Your City and Country of Birth:*

Other Information

How did you hear about Versailles Academy?*
Who will help you pay for school?*
Current Employment:*
By submitting this form, I agree that Versailles Academy may call, text and/or email me about their educational services