South Hills Learning Solutions Application Form

*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip:
*E-mail:
Company:
*Home Phone:
Work Phone:
CLASS TITLE
CLASS START DATE
PRICE OF CLASS
TOTAL PRICE OF APPLICATION:

* denotes a required field
Students are registered on a first-come, first-served basis. Payment is expected at time of application to reserve your seat in class. South Hills reserves the right to cancel classes due to lack of enrollment. Money will be refunded for any classes cancelled.