SDP Together Program Registration

Second Thursday each month (dark July):

April 10, May 8, June 12, August 14, Sept 11, October 9, Nov. 13, Dec. 11, Jan 8, Feb 12

If you have any questions, please email programs@clubtwentyone.org

Apply for a scholarship HERE.

Name

First Name *

Last Name *

Address

Country

Address Line 1

City

State/Province

Postal Code

Phone

Child's Name

First Name *

Last Name *

Child's Birthdate

Month

Day

Year

Child's Grade

What is Your Child's School Setting:

Homeschooled
General Education
Special Education
Day Program
Other

Club 21 Member?

This training is a perk of Club 21 Membership. Please confirm your membership.

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Have you attended a Club 21 SDP Learning Circle?

Please select your payment option below

Payment in full $200
$50 down payment + $50 next 3 month (be sure to select monthly payment in the credit card information section below)
I will be applying for a scholarship or using SDP Funds to pay (which is a separate application)

What month did you enroll in SDP?

Financial Management Services Name (FMS)

Service Code:

Child's UCI#:

Credit Card Information

Cardholder Name

Credit Card #

Expiration Date

Security Code

Make this a monthly payment?

Yes, charge me today and on the 21st of every following month.

Make this a monthly payment?

Your total payment will be

Your credit balance will cover

Your credit card will be charged

Your bank account will be charged

SDP Together Program Registration

Second Thursday each month (dark July):

April 10, May 8, June 12, August 14, Sept 11, October 9, Nov. 13, Dec. 11, Jan 8, Feb 12

Credit Card Information

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