Hefty Math Group Registration

  • Complete all questions on this form to register for Pacific Learning Academy's Academic Credit Hefty Math Group Program.

    Let's get started!

    Fields marked with an * are required. Scroll to bottom to save and come back later.
  • THIS IS HOW YOUR CHILD'S NAME WILL APPEAR ON HIS/HER TRANSCRIPT. Include any middle names or initials you'd like to appear on the transcript once the course has been completed.
  • Please list all parent/guardian name(s) as you wish it/them to appear on the transcript.
  • Please list the address you want to appear on the student's transcript.
  • This is the number we will call if we have questions about your registration information.
  • (Note: Choose the grade level of your student during the 18-19 school year)
  • School nameCity/StateStart mo/yyEnd mo/yy (or "current") 
    Also include any school from which your child earned high school credit (such as a Math or Foreign Language class earned in 8th grade). Include the full name of the school (no initials), ie Pine Lake Middle School. List the start and end dates (ie 09/15-06/17).
  • If you're new to Pacific Learning Academy, just choose "not sure" and we will assign you a coordinator.
  • Please list the class your student will take with Kim Hefty this school year. If you would like information about 1-on-1 courses at the Academy, please let us know by calling or emailing the office. If you are unsure of the exact name of your course, you may make a note of that in the "Class Name" field. Students seeking the Honors designation must designate it now. However, if the class pace is too much and a student would like to take the regular course, please let both Kim and the Academy know and the designation can be dropped.
    Class NameHonors?CreditsRetake?Req by NCAA? 
  • (The Hefty Group Academic Credit information document linked below should be reviewed prior to registration. Click "Select All" to check all boxes at once.)
  • Date Format: MM slash DD slash YYYY
  • This signature box must be completed by the parent/guardian of the student if the student is under 18 years of age, or by the student if the student is 18+ years of age AND has financial responsibility for the course. By signing your name in this box, you are acknowledging that the above information is true to the best of your knowledge, and that you understand and agree to the provisions above. This is considered to be an "electronic signature" under the United States ESIGN Commerce Act.

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