Student Information

Student Name(Required)

Legal First Preferred/Nickname Legal Last

Student Phone(Required)

Student Email(Required)

DOB(Required)

Enrollment Status(Required)

New Student

Existing Student (Re-Enrollment)

School Level (for 2026/2027)(Required)

Middle School Grade Level(Required)

High School Grade Level(Required)

College Year In School(Required)

School Name(Required)

School District(Required)

School State(Required)

Current Major/Field of Study(Required)

Is your student on, or will they be on, academic probation?(Required)

Yes

Does your student have any siblings currently enrolled in an Untapped Learning program?(Required)

Yes

Please list siblings currently enrolled at Untapped(Required)

Accommodations (6th-12th Grade)(Required)

Accommodations (Post-Secondary)(Required)

Other Accommodations(Required)

Does your student have any of the following diagnoses?

Is there anything else we should know about your student?

Parent/Legal Guardian Information

Parent/Legal Guardian Name(Required)

First Last

Parent/Legal Guardian Phone(Required)

Parent/Legal Guardian Email(Required)

Second Parent/Legal Guardian Name

First Last

Second Parent/Legal Guardian Phone

Second Parent/Legal Guardian Email

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Address

My billing address is different than my mailing address

Billing Contact Name(Required)

First Last

Billing Contact Phone(Required)

Billing Contact Email(Required)

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Program Information

Review Pricing & Program Options

Program(Required)

Payment Selection(Required)

Select monthly payments or to pay up-front and in full. Up-front and in-full payments are non-refundable.

Payment Type(Required)

Pay with a credit card or online bank authorization (direct debit). Credit cards incur a 2.9% convenience fee.

How did you hear about us?(Required)

Referral Name or Source(Required)

Program Policies Agreement

Program Policies Agreement(Required)

I confirm that I have read, understood, and agree to all of Untapped Learning's Program Policies

Enrollment Summary

Academic Year (Monthly): $607.50

Early Bird Discount: -$25.00

Total Due Today: $582.50*

Next Bill Due: September 9, 2026

*Credit card payments will incur a 2.9% processing fee.

First payment confirms enrollment. Coaching begins 8/9/26. Monthly billing resumes 9/9/26.

Enrollment Summary

Academic Year (Monthly): $716.67

Early Bird Discount: -$27.78

Total Due Today: $688.89*

Next Bill Due: September 16, 2026

*Credit card payments will incur a 2.9% processing fee.

First payment confirms enrollment. Coaching begins 8/16/26. Monthly billing resumes 9/16/26.

Enrollment Summary

Academic Year (Pay in Full): $6,075.00

Early Bird Discount: -$500.00

Total Due Today: $5,575.00*

Next Bill Due: N/A (Paid in Full)

*Credit card payments will incur a 2.9% processing fee.

One-time payment confirms enrollment for the full year. This plan is non-refundable.

Coaching begins 8/16/26.

Enrollment Summary

Academic Year (Pay in Full): $6,450

Early Bird Discount: -$500.00

Total Due Today: $5,950*

Next Bill Due: N/A (Paid in Full)

*Credit card payments will incur a 2.9% processing fee.

One-time payment confirms enrollment for the full year. This plan is non-refundable.

Coaching begins 8/16/26.

Enrollment Summary

Continuous Coaching: $583.33

Early Bird Discount: -$20.00

Total Due Today: $563.33*

Next Bill Due: August 13, 2026*

*Credit card payments will incur a 2.9% processing fee.

First month processed today to secure enrollment in the continuous program.

Continuous coaching must begin by July 13, 2026 to continue to receive the early enrollment discount. The next billing date will be adjusted to reflect your start date accurately.

Discount valid for 12 months. After that, continuous coaching will renew at the regular price.

Enrollment Summary

Continuous Coaching: $670.00

Early Bird Discount: -$20.00

Total Due Today: $650.00*

Next Bill Due: August 13, 2026*

*Credit card payments will incur a 2.9% processing fee.

Once submitted, your payment method on file will be billed according to your plan selections. It may take a few business days for your plan to process. If you have any questions, please reach out to billing@untappedlearning.com.

Once submitted, you will receive a link to add a payment method to your Chargebee account. If you have any questions, please reach out to billing@untappedlearning.com.

Untapped Learning Sign Up From

Student Information

Parent/Legal Guardian Information

Program Information

Program Policies Agreement

Enrollment Summary

Enrollment Summary

Enrollment Summary

Enrollment Summary

Enrollment Summary

Enrollment Summary

Let’s untap your student’s potential together.

Thank you!