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2026 The A+ Summer Program Application Form 2026 A+ Program 全方位暑期班报名表
*Only for those who don't fill in paper forms
【如已填写纸质报名表，无需重复再填】

Main Office: 1106 Commonwealth Ave. Boston, MA 02215 Tel: (617) 730-3705 Fax: (617) 730-3700

Chinatown Office: 65 Harrison Ave. 6th FL Boston, MA 02111 Tel: (617) 338-5288 Fax: (617) 391-0255

Please fill and sign this form out, and email it to info@aplusprogram.com thank you

New student application fee $30 (non-refundable) 新生报名费(不可退款)$30
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Student Status 学生状态 *
Student’s Name 学生姓名
 *
Sex 性别 *
Date of Birth 出生日期
 *
MM
/
DD
/
YYYY
Current Address 住址
 *
Email Address 电子邮件
 *
Guardian's Name 家长姓名 *
Guardian's Phone Number 家长电话
 *
Student's Insurance # / Policy # 学生医疗保险卡号码
Emergency Contact Name 紧急联系人姓名
 *
Emergency Contact Number 紧急联系人号码
 *
Name of School Attending 现就读学校
 *
Grades before September 9月前就读年级 *
Where did you hear about Academic Student Center? 您从何得知 ASC A+ Program 的?
 *
Class student is signing up For 参加班級
 *
Required
Month 月份 *
Required
Study Location 上课地点
 *
Payment Arrangement 付款方式
 *
If Check, Make check payable to Academic Student Center
(如开支票请开给 ASC)
Card Number 信用卡卡号
*Credit information is confidential, ASC will reaffirm before charges.
*您的信用卡信息将保密，ASC将在每次扣款前和您确认。
*I hereby give permission to ASC to charge the remaining balance for the session on the credit card listed, 1 week before each session begins.
*我允许ASC在每学期开学前一周,使用此信用卡收取剩余余额。
Expiration Date  到期日
Zip code 邮编
 *
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