Satellite High School

Date: ____________________

Student's Name: ____________________________________________________________

Student's Date of Birth: ______________________________________________________

Parent / Legal Guardian's Name(s): _____________________________________________

Student’s Address: ___________________________________________________________

City/State/Zip: ______________________________________________________________

Home Phone Number: (______)________________________________________________

Cell or Work Phone Number: (______)___________________________________________

Student's Current School: ______________________________________________________

Student's Current Grade Level: __________________________________________________

School's Address: _____________________________________________________________

School's City / State / Zip Code: _________________________________________________

Select one: _______ this course will be returned to your current school (ex. credit recovery, course acceleration, etc.)
OR _______ this course will be used to earn your diploma through Satellite High School

Students who choose not to take their exams at our local center in Liberty, MO must find a teacher or counselor at
their high school or in their area who will be willing to administer their exams. Exams will be mailed directly to and
from this proctor. Please complete the following information about your proctor:

Proctor's Name: ___________________________________________________________

This proctor is: ____ an administrator ____ a counselor ______ a teacher ______ other

Proctor's school address (where the exams will be mailed):

Name of the school: ________________________________________________________

School's Address: __________________________________________________________

School's City / State / Zip Code: ______________________________________________

School's Phone Number: ____________________________________________________

School's Fax Number: ______________________________________________________

OR ____ I will be taking my exams at the Satellite center in Liberty, MO

Courses cost $69 per 1/2 credit (a semester), $138 per whole credit (both semesters). STUDENTS MAY ORDER JUST SEMESTER ONE, JUST SEMESTER TWO, OR BOTH OF ANY FULL CREDIT COURSE AT ANY TIME. No refunds or exchanges are allowed after 5 business days; a sample chapter of any course may be ordered for $4. Payment methods: credit card, debit card, money order, or cashier's check payable to Satellite Middle & High School. No personal checks accepted.

Total amount enclosed: _______________

*For credit card payment:

Select one: _____ Visa _____ MasterCard _____ Discover

Account number: _____________________________ Expiration date: ____________

Security code (3 digit number on the back of the card): __________________________

Name as it appears on the card: _____________________________________________

Billing address of cardholder: _______________________________________________

Please circle which course(s) and semester(s) you are ordering at this time.

Students may order just semester 1 or 2 of any course at any time.
Thank you for your order!

Students may order ANY semester of ANY course at ANY time!

Each semester = 16 lessons, 2 midterm exams, and a final exam.

Courses marked with ** are 100% testing.
All other courses require a combination of homework assignments and exams.

Courses are printed on paper. Courses are not online.