Miami MicroLearn Hub

Reserve a spot for your student(s) now by completing this form and paying the $250 non-refundable/non-transferable application fee.  You will be required to pay for the enrollment plan of your choice by September 1, minus the application fee, to keep your spot(s) in the Academy. 

Note:  you can reserve spots and pay application fees for up to 4 students on one form.  You must complete a separate form if you wish to reserve and pay for more than 4 students.

Are you reserving a spot for more than one student? *

• Yes
• No

If more than 1, how many spots are you reserving?

• 2
• 3
• 4

Parent/Guardian Information

Parent/Guardian *

First

Last

Parent/Guardian's email *

Email

Confirm Email

Parent/Guardian's mailing address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Parent/Guardian's mobile number *

Including area code

Parent/Guardian's work number

Including area code

Parent/Guardian's occupation *

Student Information

Student's name *

First

Middle

Last

Student's email

Email

Confirm Email

example@example.com

Student's mailing address (if different from parent's)

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Student's date of birth *

Format: mm/dd/yyyy

Student's gender *MaleFemalePrefer not to identify

Click dropdown arrow to select gender.

Student's previous school district/school *

Student's grade level for 2020-21 school year *

Select student's desired Education Investing Plan *K-5 Plan AK-5 Plan BK-5 Plan C6-12 Plan A6-12 Plan B6-12 Plan C

Student 2

2nd Student's name *

First

Middle

Last

2nd Student's email

Email

Confirm Email

example@example.com

2nd Student's mailing address (if different from parent's)

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

2nd Student's date of birth *

Format: mm/dd/yyyy

2nd Student's gender *MaleFemalePrefer not to identify

Click dropdown arrow to select gender.

2nd Student's previous school district/school *

2nd Student's grade level for 2020-21 school year *

Select 2nd student's desired Education Investing Plan (copy) *K-5 Plan AK-5 Plan BK-5 Plan C6-12 Plan A6-12 Plan B6-12 Plan C

Student 3

3rd Student's name *

First

Middle

Last

3rd Student's email

Email

Confirm Email

example@example.com

3rd Student's mailing address (if different from parent's)

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

3rd Student's date of birth *

Format: mm/dd/yyyy

3rd Student's gender *MaleFemalePrefer not to identify

Click dropdown arrow to select gender.

3rd Student's previous school district/school *

3rd Student's grade level for 2020-21 school year *

Select 3rd student's desired Education Investing Plan (copy) *K-5 Plan AK-5 Plan BK-5 Plan C6-12 Plan A6-12 Plan B6-12 Plan C

Student 4

4th Student's name *

First

Middle

Last

4th Student's email

Email

Confirm Email

example@example.com

4th Student's mailing address (if different from parent's)

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

4th Student's date of birth *

Format: mm/dd/yyyy

4th Student's gender *MaleFemalePrefer not to identify

Click dropdown arrow to select gender.

4th Student's previous school district/school *

4th Student's grade level for 2020-21 school year *

Select 4th student's desired Education Investing Plan (copy) *K-5 Plan AK-5 Plan BK-5 Plan C6-12 Plan A6-12 Plan B6-12 Plan C

Choose the application fee amount based on your number of student reservations. *One student - $ 250.00Two students - $ 500.00Three students - $ 750.00Four students - $ 1,000.00

Credit Card Information *

Card

Name on Card

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