InTech - Fees

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ICHS 2017-18 Enrollment Lottery Application

Applicant Student Name	First Name		Last Name
Applicant Student Name

Applicant Student's Birthdate

Day

Month

Year

Applicant Student's Grade Level in 2017-2018

Name(s) of sibling(s) already attending ICHS

Name(s) of sibling(s) also applying for the lottery

Parent/Guardian Information

First Name:	Last Name:
Address:
Address:
City:	State/Province:	ZIP/Postal Code:
Phone:
Email:

Payment Information:

Method of Payment:	Credit/Debit Card eCheck
Update Name from Above

Name on Account:
Routing Number:
Account Number:
Institution:

Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:

Change Payment Method

ICHS gives additional weight (a better chance of selection) in its enrollment lottery to students from low income backgrounds (those who qualify for fee waivers or free lunch). Those desiring to increase their chance of selection with this additional weighting must provide confidential verification of qualification prior to the Jan 31, 2017 enrollment lottery.

Check here if you would like your income status to be reviewed to determine if you qualify.

I would like my income status to be reviewed.

Please be aware that payments will reflect on your statement as

CBT*INTECH COLLEGIATE and CBT*SVC INTECH CH

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