Diploma Program Registration Form – MDHSA Diploma Program

NOTICE: The Diploma Program registration fee is increasing to $55 per student on 9/1/24. If you have a student that will be graduating in 2028 or before, you can still register your student for $40 until September 1. However, if your student is graduating in 2029 or later, you must pay the $55 fee effective immediately.

REGISTRATION STEPS:
1) Register your student by filling out the form below and submitting payment via PayPal.
2) Once PayPal has confirmed/processed your payment, you will receive a Welcome mail that will confirm your student’s registration, provide you with basic information about the program, and give you the Diploma Program Participant password that allows you to access certain restricted forms.

Occasionally, some individuals have difficulty with PayPal accepting their payment. If this happens to you, try resubmitting the form a few times. If you still continue to have problems, you can either use the printable registration form and mail it with a check or money order or contact diploma@masondixonhomeschoolers.org for another alternative.

DIPLOMA PROGRAM REGISTRATION

STUDENT'S Name *

First

Last

Expected Graduation YEAR (Format YYYY) *

Supervisor (Parent's) Name *

First

Last

Email *

Phone Number *

Alternate Phone Number

Student's Date of Birth *

OPTIONAL: Student's Social Security Number - LAST FOUR (xxx-xx-####)

The last four digits of the Student SSN is used for Transcripts for colleges and may be omitted if there is an objection to providing this information. If not provided at the time of Registration, the information may be sent to MDHSA at a later date, if needed.

Date *

Street Address *

City *

State *

Zip Code *

REQUIRED: YOU MUST READ THE FOLLOWING STATEMENTS AND ACKNOWLEDGE BELOW THAT YOU ACCEPT THEM. We have read the MDHSA Diploma Program Guide and the ADVISEMENT and we understand our responsibilities and privileges in this Program. We also certify that all the information on each Annual Summary Form and Transcript will be / is true and accurate. THE MDHSA TRANSCRIPT IS A LEGAL DOCUMENT AND COPYRIGHT PROTECTED. We will use the MDHSA name and the Transcript form only on or for an MDHSA Transcript. We will not print a draft that has not been seen or approved or signed by the MDHSA office and pass it on to any person, college, employer, or other institution, as official. By typing our names below, we are digitally signing this electronic Diploma Program Registration Form and are agreeing to these statements. Failure to agree and adhere to the terms of the Diploma Program will result in a forfeiture of the Registration Fees and non-admittance in the MDHSA Diploma Program.

Student Signature (Type Name) *

I have read the above REQUIRED statement and the MDHSA Diploma Guide and agree to abide by MDHSA's policies and procedures.

Parent (Supervisor) Signature (Type Name) *

I have read the above REQUIRED statement and the MDHSA Diploma Guide and agree to abide by MDHSA's policies and procedures.

Diploma Program Registration Fee (see fee NOTICE at the top of this page) *

Diploma Program Registration Fee (NONREFUNDABLE) - $55.00

*Every family must own/read a copy of the MDHSA Diploma Guide to participate in the program. If you have not already purchased a copy, you may order a PDF at https://masondixonhomeschoolers.org/dp/wp-content/uploads/2023/10/PUBLICATIONS-ORDER-FORM-2023.pdf.

Total

$0.00

You will be redirected to PayPal once you click on "Submit." You will have the option to pay with a Debit or Credit Card. Your registration is not complete until payment has been made.