E-Flex Enrollment Form
This form is for students and a parent or guardian to enroll into the E-Flex program with Orion Diploma Completion. Only students with a corresponding counselor referral will be approved.
STUDENT INFORMATION
What high school do you currently attend? *
Student First Name *
Legal first name.
Student Last Name *
Legal last name.
Student Middle Initial
If you do not have a middle name, please leave blank.
Student Preferred Name
If you go by a name other than your legal name.
Gender *
Date of Birth *
MM/DD/YYYY
Last Four Digits of Social Security Number *
For password and security purposes.
Student Phone Number
May we text you?
Message and data rates may apply.
Clear selection
Student School Email Address *
Assigned by the student's school district
Street Address *
City *
State *
Zip Code *
Have you ever enrolled with Orion Diploma Completion before? *
If you answer yes to the question above, which program? And when?
PARENT OR LEGAL GUARDIAN INFORMATION
Parent or Legal Guardian Full Name *
Main Phone Number *
Include area code. Example: 123-456-7890
May we text your main phone number? *
Message and data rates may apply.
Alternate Phone Number
Include area code. Example: 123-456-7890
May we text your alternate phone number?
Message and data rates may apply.
Clear selection
Parent or Guardian Email Address *
Confirmation of enrollment will be sent to this email address.
PAYMENT AGREEMENT
I agree to pay the course fee prior to beginning each course. I recognize that the fee is non-refundable. Payment should be made at oriondiplomacompletion.org using our secure webstore.
Student Signature *
Parent or Legal Guardian Signature *
Date *
MM
/
DD
/
YYYY
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