American Heritage Education Inquiry Form Plantation Campus

Please provide information about the parent/guardian. Please provide either email or phone number for us to contact you.

Parent First Name*

Parent Last Name*

Parent Email*

Contact Phone Number*

Address

City

State

Zip

Information about course options

Specific Courses/Classes

Session Dates (You can chose more than one)

PSAT/SAT test prep

Yes No

Grade Forgiveness (Fill in Course/Class)

Please provide information about your child(ren).

Child First Name

Child Last Name

Age

Current Grade

Current School

Do you want to enter another child's information

Yes No

Child First Name

Child Last Name

Age

Current Grade

Current School

Do you want to enter another child's information

Yes No

Child First Name

Child Last Name

Age

Current Grade

Current School

Please select all the education programs you wish to receive information.

Summer Education

Summer Institute for Advancement/Enrichment Summer School (Grade forgiveness/improvement/remedial)

American Heritage Planation Campus
12200 West Broward Blvd
Plantation , FL 33325
(954) 472 -0022