Excel Center Online Application

Items indicated with a * are required

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Tell us why you are interested in attending the Excel Center and how you heard about us (optional)


Home Language Survey


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Race/Ethnicity


Is the individual Hispanic/Latino? *

Yes
No

What is the individual's race? (You may select more than one) *
American or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

High School History


What was the last high school you attended? if not in Indiana list city,state
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High School Credits *

No Credits

I Have Credits


Have you ever received special education services? *
Yes No

The following items are required to complete your application for enrollment:


Please submit the required information to:

The Excel Center
2721 Kenwood Avenue
South Bend, IN 46628
Fax: (574) 314-5571

Signature


NOTE: By typing your name into the signature section you are signing these enrollement forms

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