Central Susquehanna Intermediate Unit

PA: Central Susquehanna IU - Summer School 2019 for HIGH SCHOOL (grades 9-11)

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Note: A service fee of $2.50 or 2.95% (whichever is greater) will be assessed for card payments. A fee of $2.00 will be assessed to payments made from checking/ savings accounts. The service fee will appear on the next page. If you do not agree to these terms, please click ‘Cancel’ below and make different payment arrangements. VISA, MasterCard and Discover cards accepted.

HIGH SCHOOL STUDENT SECTION

Student Last Name

Student First Name

Student Email

D.O.B.

Gender

Male Female

Do you have an IEP (Individualized Education Plan)?

Yes

PARENT/GUARDIAN SECTION

Parent/Guardian Last Name

Parent/Guardian First Name

Parent Email

Parent Phone #

Parent Phone # Area Code-Parent Phone # Prefix-Parent Phone # Line Number ext Parent Phone # Extension

HIGH SCHOOL SECTION

Please Do Not Complete The Following Field

School District

Other? If your district is not listed please type in name here

Grade Level Completed

COURSE SECTION (Registration Opens from May 30, 2019 to June 13, 2019! If Cancelled by May 30, 2019 a refund of the course fee will be refunded in full; partial refunds will be offered if cancellations are received on or before June 21, 2019.

To cancel your course registration, you MUST email: Audrey Jows @ ajows@csiu.org

Course 1

Course 2

Note: Refunds will be processed less the service fee.

Note: To continue to payment, please click CHECKOUT below. However, if making a payment for another computer workshop, click ADD TO CART.