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Smoky Hill Education Service Center

Virtual Learning


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Adult Performance-Based Diploma Program Contact Request Form


First:     Last:

Address:     City:     

State:     Zip:

E-mail  Address:

Home Phone:     Cell Phone:

Birth Date:     Age:    


Have you graduated from high school?   

Graduation year:


How/where did you hear about the Smoky Hill Learning Center?

Internet Friend Advertisement School Other

Required Documents

  • Transcripts from all previous schools attended
  • Official photo identification - REQUIRED FOR ALL STUDENTS


 Today's Date: