Student Interest Form
Welcome to Project Encore! We are looking forward to helping you earn your high school diploma. Our program is free to Kansas residents that are high school age or beyond. Please fill out this form so we can help get you started earning credits. Once you submit your form, we will contact you within 24 hours.
Do you have a high school diploma? If you answer YES to this question, you are not eligible to enroll in our program. *
Are you a Kansas resident? If you answer No to this question, you are not eligible to enroll in our program. *
How did you hear about us? *
Have you enrolled in an Encore program before? *
If you answered YES to the previous question, please identify which program. *
First Name *
Your answer
Last Name *
Your answer
Middle Name *
Your answer
Maiden Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Date of Birth (MM/DD/Year) *
Your answer
Age *
Your answer
Primary Contact Number - include area code *
Your answer
Alternate Contact Number - include area code *
Your answer
E-mail Address *
Your answer
Has your original class graduated high school? *
If you answered Yes to the previous question, what year did your original class graduate?
Your answer
What is the name of the last high school you attended? *
Your answer
What was the last grade level you completed? *
What is the Name of the City and State where your last high school is located? *
Your answer
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