Online Registration

Upon submission of the Operation Reconnect Registration form, a representative from our office will contact you as soon as possible.

* Indicates required field

Student Name *

First

Last

Student Age *

Date of Birth *

Social Security Number *

Last Grade Completed *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Parents Name OR Emergency Contact *

First

Last

Phone Number *

If Other, explain *

I could use some extra help in: *

Math Reading English/Grammar Life Skills

Recruitment Code *

Submit

Now that you've submitted your enrollment form, it's time to set up our first video meeting. This will give us a chance to get to know you, answer any questions you may have, and set up a plan for graduation!. Just click the calendar below and set your appointment:

Upon submission of the Operation Reconnect Registration form, a representative from our office will contact you as soon as possible.

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