Untapped Learning Sign Up From

We are excited to work with your student in the next academic year! Complete this form to secure your student's spot in the program. Scheduling links will be emailed to enrollees mid to late July.

Student Information

Student Name(Required)
MM slash DD slash YYYY
Enrollment Status(Required)
Is your student on, or will they be on, academic probation?(Required)
Does your student have any siblings currently enrolled in an Untapped Learning program?(Required)
Does your student have any of the following diagnoses?

Parent/Legal Guardian Information

Parent/Legal Guardian Name(Required)
Second Parent/Legal Guardian Name
Mailing Address(Required)
Billing Address
Billing Contact Name(Required)
Billing Address(Required)

Program Information

Review Pricing & Program Options

Select monthly payments or to pay up-front and in full. Up-front and in-full payments are non-refundable.
Pay with a credit card or online bank authorization (direct debit). Credit cards incur a 2.9% convenience fee.

Program Policies Agreement

Program Policies Agreement(Required)

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.