STUDENT TRANSFER APPLICATION

If you were enrolled in previous versions of the Alchemy Home Study Program

or were a student at Flamel College, please fill out and submit this application

for enrollment in the new program. We will check the information you provide

and determine whether you were an active student in program. This process

may take up to three weeks to complete. You will be notified by email.

Name: *

E-mail Address: *

Address: *

City: *

State/Province: *

Postal Code: *

Country: *

Date of Enrollment: *

Paid Modules: *
Paid for each Module Separately Paid for Module 7 Separately Prepaid Modules 1-6 Prepaid Modules 1-7 (none of the above)
Last Module Received: *

Comments:


Verification Code:
Enter Verification Code: *


* Required