If you would like to apply now for a Huntington Learning Center franchise, please complete the fields below or call 1-800-653-8400.

First Name*: Last Name*: Date of Birth: Address*: Email Address*: City*: State*: Zip*: Home Phone*: Citizen of: How long at this address? Do You: Own   Rent Previous Street Address: Previous State*: Previous City*: Previous Zip*: Marital Status: Married Single Separated Divorced   Spouse's name: Children living at home: Males: Ages: Females: Ages: Names of civic, fraternal, or professional organizations to which you or your spouse belong:     From To Firm Position Annual Income Executive-level experience?   No Yes If yes, describe:         Do you now own or have you ever owned any franchise?   No Yes If yes, describe:         Are any lawsuits pending against you?   No Yes If yes, describe:         Have you ever been convicted of a crime (except traffic misdemeanors?)   No Yes If yes, describe:         High school graduate     Some college     College graduate     Advanced study or degree     School Degree Year Completed Who will operate your Huntington Learning Center, and what role will your spouse play? Please describe the general geographic area you desire to develop: When would you like to open your Huntington Learning Center? How did you hear about our franchise? Wall Street Journal Referral from: Other As of , 20 This is a statement of:   My individual financial condition The financial condition of my spouse and me Assets   Amount Liabilities   Amount Cash in banks $ Notes payable to bank $ Real estate $ Real estate amount owed $ Stocks and Bonds $ Loans on life insurance policies $ Accounts receivable $ Other liabilities (describe) $       Cash surrender value of your life insurance $       Auto $ Year and Make   Other assets $ (describe)           TOTAL ASSETS $ TOTAL LIABILITIES $ NET WORTH (Total assets minus total liabilities) $       ANNUAL INCOME ANNUAL EXPENDITURES Salary or wages $ Property taxes and assessments $ Dividends and interest $ Federal and state income taxes $ Rental income (gross) $ Real estate loan payments $ Business or professional income (net) $ Payments on contracts and other notes $ Other income (describe) $ Estimated living expenses $       TOTAL INCOME $ TOTAL EXPENDITURES $ How much capital are you able to invest? Do you currently have a source of financing?   Yes No Will you use personal assets to finance this franchise?   Yes No     Please explain:     Have you filed for bankruptcy or compromised a debt during the past seven years?   Yes No     If yes, please explain:     Are your cash deposits held in joint tenancy?   Yes No     With whom? Please use this space to tell us anything else you think is relevant, such as family business history, your personal business objectives, and what your most significant contribution would be to this business. I understand that this is not a contract, but an application for a Huntington Learning Centers, Inc. franchise. By signing this, I represent that all statements on this Confidential Application are true and correct, unless a written notice of change is given by me to Huntington. Huntington Learning Centers, Inc. may verify any of this information, and may check my credit and employment history. Date * - indicates required fields. By submitting this request you authorize Huntington Learning Centers, Inc. to send additional information on becoming an operator of a Huntington Learning Center franchise.

This is not an offer to sell a franchise. This franchise is offered only by our delivery of a franchise disclosure document to you
in compliance with the Federal Trade Commission's rule on franchising and various state franchise sales laws.

© 2010 Huntington Mark, LLC, Independently Owned and Operated. HLC-1626