Lev Academics Registration Form
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Email *
Student First Name (Legal Name Required)
 *
Student Last Name
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Current Home School
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Student Date of Birth *
MM
/
DD
/
YYYY
Student Gender *
Canadian Status *
OEN Number (Ontario Education Number - 9 digits)
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Address
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City
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Province
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Postal Code
 *
Student Phone Number
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Student Email Address (Personal email, not school email and ideally Gmail)
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Parent/Guardian First Name
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Parent/Guardian Last Name
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Parent/Guardian Phone Number
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Parent/Guardian Email Address
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Parent/Guardian Relationship to Student
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Course(s)

** Prerequisite: Any grade 11 or 12 U/M course in Canadian and World Studies, English or Social Sciences.
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Required
Does student have an IEP? *
Prerequisite Status - Please provide proof by emailing a copy of your students transcript or report card to gillian@levacademics.com.
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I give Lev Academics the right to collect and share student academic information to and from previous and current academic institutions.
*
Required
A copy of your responses will be emailed to the address you provided.
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