Durham Performance Learning Center - Enrollment Interest Form
If you are interested in enrolling at the DPLC, please complete the form below. Once complete, one of our counselors will be in touch with you with more information. Please note - completion of this form does not guarantee acceptance into the DPLC.
Student First Name *
Student Last Name *
Student Current School *
Home Address *
Parent Phone Number *
Parent Email Address *
Student Cell Phone Number *
Student Email Address *
What is the reason you are interested in or were referred to the DPLC? (check as many as are applicable) *
Who referred you to the DPLC? *
Why do you wish to attend the Durham Performance Learning Center? Please include the following information: academic strengths and weaknesses and post-high school plans. *
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