To maintain the integrity of each student's information, do not create more than 1 account per student.
- If you have an existing account but are having trouble logging in, click here.
- If you have an existing account and know your username and password, log in.
Student Information
* Student First Name
Student Middle Name
* Student Last Name
* Student Email
* Student Email (confirm)
Gender
* Date of Birth
* Address
Address 2
* City
* State
* Zip
* Home Phone
Student Cell
* School
School (write-in)
* Grade (2018/2019)
Tutor's Name
Referred By
Special Testing Accommodations
Student is approved for testing over multiple days.
Student is approved to use computer for essay.
Student is approved to circle answers in test booklet.
Parent Information
* Parent 1 Name
* Relationship to Student
* Parent 1 Cell
* Parent 1 Email
* Parent 1 Email (confirm)
Parent 2 Name
Relationship to Student
Parent 2 Cell
Parent 2 Email
Parent 2 Email (confirm)
Payment Information
We require payment by Visa, MasterCard, American Express, or Discover. All services rendered will be charged to your credit card on file on or about the 15th and 30th of each month. You will receive a statement by email detailing all charges.
* Cardholder Name
* Credit Card Number
* Expiration Date /
* CVC Code
* Billing Zipcode
 
* Cardholder Phone
* Cardholder Email
Account Options
* Username
* Password
* Password (confirm)
* Confirmation Emails to
Student    Parent 1    Parent 2    All
* Your Relation to Student
I agree to pay Bespoke Education, Inc. for any services rendered. I have read, understand, and agree to the Service Agreement, which sets forth Bespoke's policies relating to payments and credit card use.