Welcome Project MEGSSS families to the Elements 2022-2023 Academic Year! We are excited for your students to join our program as we return to in person instruction. Student Profile Student First Name * Student Last Name * Birth Date * Current Grade * - select Current Grade - 3 4 5 6 7 8 9 10 Race African-American or BlackAsianBiracial or MultiracialCaucasian or WhiteEastern EuropeanHawaiian or Pacific IslanderHispanic or LatinoMiddle EasternNative American or Alaskan NativeA Race/Ethnicity Not Mentioned Here/OtherPrefer Not To Answer Gender ID Female Male Transgender Email * Street Address * City * Country * - select Country - United States Canada State * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * 2022-2023 Elements After School * 1st Year Cohort Tuition - $ 1,650.00 2nd Year Cohort Tuition - $ 1,650.00 3rd Year Cohort Tuition - $ 1,650.00 1st Year Cohort Fall Semester Tuition - $ 825.00 1st Year Cohort 1st Month Payment - $ 165.00 2nd Year Cohort Fall Semester Tuition - $ 825.00 2nd Year Cohort 1st Month Payment - $ 165.00 3rd Year Cohort Fall Semester Tuition - $ 825.00 3rd Year Cohort 1st Month Payment - $ 165.00 Total Payment Options Payment Method Credit Cards Pay later Credit Card If you have a PayPal account, you can click the PayPal button to continue. Otherwise, fill in the credit card and billing information on this form and click Continue at the bottom of the page. Pay using PayPal Checkout securely. Pay without sharing your financial information. Card Type - select - Visa MasterCard Amex Discover Card Number * Security Code * Expiration Date * -month- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec -year- 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 My billing address is the same as above Billing Name and Address Billing First Name * Billing Middle Name Billing Last Name * Street Address * City * Country * - select - United States Canada State/Province * - select State/Province - Alabama Alaska American Samoa Arizona Arkansas Armed Forces Americas Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas United States Minor Outlying Islands Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Postal Code * Parent Profile Parent Name * Parent Emergency Phone Number * Parent Email * Additional Emergency Contact Name Additional Emergency Phone Number Review your registration
