Application/Registration Form
Social Security #
Phone #
Msg. Phone
Last Name
First Name
Middle Name
Street Address
Apt #
City
State
Zip
Date of Birth
Age
Sex
Highest Grade Completed
Current Transcript	Yes No
If you are accepted into the High School Completion program, the total cost of the program is $525.00.  This includes a $50.00 non-refundable Registration Fee.
For students out of the area, an additional $50.00 Proctor Fee will need to be paid before examination materials can be mailed.

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Northwest School of Success, Inc.

204 S. John Adams
Oregon City, Oregon 97045

Telephone:
(503) 656-4478

FAX:
(503) 656-4199

Toll Free:
1-866-657-4001