Inquiry 2025-2026

Student Information

Suffix

Can this number receive texts?required

Yes
No

How would you prefer to be contacted?

Genderrequired

Which campus would you like to attend?required

I prefer to attend classes: (New Heights staff will do their best to accommodate your schedule, if a conflict arises we will call you.)required

In the past I have participated in the following programs: please select all that apply

SPED: Resource

SPED: Inclusion

SEAS

BIC

RISE

DYSLEXIA

504

None of these programs applied to me

Transportation needs:required

I NEED assistance with bus passes to get to and from school.
I DO NOT need assistance with transportation.

Childcare needs:required

I have a child/children 5 or under that will need child care while I am attending classes.
I DO NOT need child care assistance.

Home/Residential Information

Staterequired

Is your mailing address different than the physical address listed above?required

Mailing Address

Staterequired

Emergency Contact

Contact 1

Title

Suffix

Relationship to Studentrequired

Phone Typerequired

Applicant Questionnaire

How did you hear about us?required

Student Refferal
Billboard
Social Media
Website

New Heights Navigator Referral Program

I was referred to New Heights by an active (currently enrolled) New Heights student.

Electronic Signature

The electronic signature below and its related fields are treated by the organization as a physical handwritten signature on a paper form.

I verify that all the information provided is true and correct to the best of my knowledge.

I agreerequired