*First Name:

*Last Name:

*Email address:

Phone Number: Please give us the number you would like us to use to contact you about your award.

*Street address:

*City:

State:

*Zip code:

*Birthdate: ... Format: YYYY-MM-DD (eg: 2003-12-25 for Christmas day)

*Approximately how many credits will you be transferring from public or accredited private schools? Choose only one of the following Please choose.. 0 1.0-5.0 6.0-10.0 11.0-15.0 16.0 or more

*How soon do you plan to complete your diploma requirements at The American Academy? Choose only one of the following Please choose.. within the next 6 months in the next year in the next two years in the next three to four years

*How much time do you plan to commit to your courses each week? Choose only one of the following Please choose.. 5 hours or less 6-10 hours 15-20 hours 30 hours or more

*Please tell us your story. Why are you interested in earning your diploma online? How will The American Academy help you achieve your goals?

*We select a number of students to tell their stories on our website and other marketing materials. Can we publish portions of your essay if you are selected for a scholarship? Yes No Note, we will not use full names on our website.