Junior Packet, Senior Profile, or Counselor Questionnaire Review and Revision Express Service
Please complete the following information and submit the payment to USCECC.

Check payable to: USCECC
USCECC-Veritas Education
2501 Clover Field Circle
Herndon, VA 20171


*Early bird discount can't be combined with other promotions
**Payment must be received by the early bird deadline in order to receive the early bird rate, please plan the payment time accordingly as it may take longer for a check to arrive by mail.
Student first name *
Your answer
Student last name *
Your answer
Student email address *
Your answer
Student current school *
Your answer
Junior packet/senior profile/counselor questionnaire form due date *
Parent name *
Your answer
Home address *
Your answer
Parent email address *
Your answer
Parent cell phone number *
Your answer
Parent's Wechat *
Your answer
Registration: Please select the date of the workshop your family will attend
Early Bird and tuition:
$ 320 - Registered and paid by 5/19/2020
$ 360 - Registered and paid by 6/23/2020
$ 400 - Registered and paid by 8/12/2020
*One-on-one service is also available - hourly and package rates are available. Hourly rate is $250 for the first hour and $170 for the subsequent hours
Junior/Senior Packet Workshop (choose one) *
How did you hear about us? *
Payment option (online option preferred - no credit card option available) *
Special instruction
Your answer
By printing my name below and/or paying the fee, I understand and agree with the policy that the tuition is not refundable after the workshop starts. Parents also give permission to Veritas Education to use, as its own property, for publicity, advertising or other reasonable commercial purposes, without compensation to the Student or their family, any photos, audio recording, video, slides, films or other media taken of the student by Veritas Education containing the student's image, voice or words. 
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy