School Record Information – Confidential

Complete this form in its entirety related to the institution and the last 3 years of enrollment and withdrawal information.

Contact Information

School Information

School Type *

Would you like students on Payment Plans to have Coverage? *

Grade Levels Served *

Number of Students Enrolled

Year Total Enrollment Tuition Received % on Payment Plans Discount Rate (Scholarships / Financial Aid)
2024/2025
2023/2024
2022/2023

Enrollment Funds Received by Payment/Payment Plan

Year Annual Enrollment Semi-Annual Quarterly Monthly
2024/2025
2023/2024
2022/2023

Enrollment Breakdown by Grade Level

Year Pre-K & K # Pre-K & K $ Grades 1-8 # Grades 1-8 $ Grades 9-12 # Grades 9-12 $
2024/2025
2023/2024
2022/2023

Withdrawal by Category

Year Medical # Medical $ Non-Medical # Non-Medical $
2024/2025
2023/2024
2022/2023

Initial below to certify you are authorized to provide the above data and consent to its use for generating a quote for the GradGuard Tuition Protection Plan.