Email Address

Contact Phone

Current School

Current GPA_____Class rank____(if known)__

Have you developed a list of colleges? Y/N If so, please fill-in below.

1.__________________ 2____________________ 3.__________________ 4.___________________ 5.__________________ 6.___________________

Referring a student: _Y___N___

1st Student referral:________________

2nd Student referral:_____________

Payment Information

Please send a check to: Friarworks907 11500 Discovery Hts. Cir Anch., Ak. 99515 Checks must be sent 1 week before the 1st class.

Thank you!

I look forward to working with you! If you have further questions, please do not hesitate to contact me: friarworks907@gmail.com