AK Grad Registration Form
Please fill out all applicable fields. The Supervising Instructor will receive a confirmation email after the form is submitted.
STUDENT INFORMATION
Student Name (First & Last)
Your answer
Student Email Address
Your answer
Student Mailing Address (If Books Are Needed)
Your answer
Student Telephone Number
Your answer
SUPERVISING INSTRUCTOR/SCHOOL DISTRICT INFORMATION
Supervising Instructor Name (First & Last)
Your answer
Supervising Instructor Email Address
Your answer
Supervising Instructor Phone Number
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School District or Sponsoring Organization
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School District or Sponsoring Organization Address
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PARENT OR GUARDIAN CONTACT INFORMATION
Parent/Guardian Name (First & Last)
Your answer
Parent/Guardian Email Address
Your answer
Parent/Guardian Phone Number
Your answer
Requested Courses
If Buzz AK Grad Online Courses, use course number, such as Bio54, if Canvas Credit Recovery course, use name: Biology. List all courses and quarters requested.
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