Registration


Science Cosmos Secure Online Registration

Optin to receive emergency and schedule notifications on your mobile. Enrollment form for Chantilly Branch and affiliated sites. http://www.sciencecosmos.com/chantilly
*PLEASE TYPE IN DESIRED SESSION IN THE COMMENT SECTION AT BOTTOM OF FORM*

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Referral Information
Family Information
Where do you live?
Contact #1
How Can We Contact You?
Portal Access (your email is your login)
(Emails are kept confidential)
Student #1
Additional Info
Enroll in Classes
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Payment Information
Please fill out ONE of the following Payment Methods
Credit Card
eCheck/Bank Draft
(Your name on your bank statement)
(9-digit number)