School Enrollment Form
Applicant Information
Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
Marital Status
Please Select
Single
Married
Divorced
Widow
Separated
Religion
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Birth
Email
*
example@gmail.com
Mobile Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Application Details
Educational Background
*
High school
GED
Associate's
Bachelor's
Other
Diploma or Transcripts
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload your ID picture here
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Immunization Records
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Physical Examination Form
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Educational Background
Name of School
*
School Address
*
Street
Street Address Line 2
Municipality
State / Province
Postal / Zip Code
Year Graduated
*
Back
Next
Contact In case of Emergency
Name
First Name
Middle Name
Last Name
Mobile Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship
Back
Next
Full Name of Applicant
First Name
Last Name
Applicant's Signature
Back
Next
Please download form CDPH 283B fill out and upload here: https://www.cdph.ca.gov/CDPH%20Document%20Library/ControlledForms/cdph283b.pdf
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please download form BCIA 8016 Live Scan fill out and upload here: https://oag.ca.gov/system/files/media/BCIA-8016.pdf
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Submit
Should be Empty: