Student Enrollment Form

Instructions: Fill out the following information completely and sign and date the last page.
Notify us immediately if any of your information changes

W526 Division Street, Stephenson, MI 49887 | Phone: (313) 335-3218 | www.uplift-mi.org

Student Information

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NEED HELP WITH ENROLLMENT? CALL 313-335-3218 
We look forward to hearing from you.