Please complete the following form to pay tuition, field trips, late fees or any other fees. "*" indicates required fields Note: Do Not use ENTER to move between fields, use Tab or Touch. As you make selections, additional lines will display based on those selections. The “Pay Now” button won’t appear until the “Credit Card” section displays.Student NamePlease tell us the name of the student for which this payment is being made. First Last Payment TypeYou may pay more than one item by selecting one or more boxes. The “Yearly Supply Fee” and “Enrollment Fee” are set amounts. The remaining items will create another field so you can enter an amount. “Field Trips” will display a second field so you can enter a description about the amount. Deselect a box by clicking or touching again. Tuition Yearly Supply Fee Field Trips Enrollment Fee Late Fee Tuition AmountPlease tell us the amount of tuition you are paying. Annual Supply FeeThe annual supply fee is $100. Price: Enrollment FeeThe enrollment application fee is $35. If you haven’t completed the form, please download the full application from our website at Achievement Center of Texas Enrollment Form. Price: Field Trip FeePlease tell us the amount you are paying for field trips. Field Trip Description*Example: I am paying $6 for the zoo trip + $12 for concessions. If paying for more than one field trip, tell us which ones. Late FeePlease tell us the amount of any late fees you are paying. TotalThis is the total amount of your payment. Payor Name*Please provide the name of the person making this payment. First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhonePlease provide a telephone number so we can contact you if additional information is needed.Email*A receipt will be sent to this email address. Unless you are already on our email list, you will not be added to a new one. Enter Email Confirm Email Additional InformationYou may provide an explanation or additional information regarding this payment.Credit Card PhoneThis field is for validation purposes and should be left unchanged.