DLX Registration Form

Please only use this form as directed by your school, distributor, or DLX Academic Administrator. For initial inquiries, please see our Apply Now page.

General Information

Student Name

First

Last

Student Email

Date Of Birth

Country

Grade Level

School Year

Desired Student Username

Desired Student Password

Eight characters minimum One lowercase letter One uppercase letter One number One special character

School and Program Information

School Name

School Address (If homeschooled, please add your current city and country)

City

State/Province

Zip/Postal

Country

Desired Program

Terms Start Date

End Date

Teacher/ Coordinator Name

Desired Teacher/Coordinator Username

Parent Information

Parent Name (Full)

Parent 2 Name (Full) * (Optional)

File Upload

Maximum file size: 10MB

Payment Information

Full name of person making the payment

Address

Phone Number

Country

State

Note: This is for financial records only, after credit approval and registration, an invoice will be sent to this email for confirmation and payment.

Preferred Contact for Course Evaluation Communication

Contact Name

Contact Role

If you are human, leave this field blank.

Location

Email

DLX Registration Form

General Information

School and Program Information

Parent Information

Payment Information

Preferred Contact for Course Evaluation Communication

Start Your Educational Journey with DLX

Location

Contact Email

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Contact Info

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