Enrollment Empowering the Future of Online Education Step 1 of 2 50% Fill out the application below to register your student at Empowered Scholars.This field is hidden when viewing the formStatusSubmittedApprovedDeniedInactiveStudent InformationStudent Name(Required) First Middle Last Date of Birth(Required) MM slash DD slash YYYY Gender Identity(Required)Select OneFemaleMaleCis FemaleCis MaleTrans FemaleTrans MaleGenderfluidNon-binaryIntersexTwo SpiritOtherPreferred Pronouns(Required)Select OneHe/HimShe/HerThey/ThemOtherOther Gender IdentityOther Preferred PronounsEthnicity(Required)Select OneHispanic/LatinoNot Hispanic/LatinoRace(Required)Select OneBlack or African AmericanIndigenous AmericanAlaska NativeAsianNative Hawaiian Or other Pacific IslanderWhiteCurrent Grade Level(Required)Select One6789101112Student's Email(Required) Must be different than parent’s emailStudent's Phone Number(Required)Student's Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Information 1Parent Name 1(Required) First Last Parent's Email(Required) Phone(Required)Parent's Address(Required) Same as student's address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent's Information 2Parent Name 2 First Last Parent's Email PhoneAddress Same as student's address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Additional InformationIs there anything you would like us to know about your student?Do you have another student enrolled or previously enrolled in our school?(Required) Yes No What is your username? {all_fields}
