Wufoo

Student Name * First Last
Student Email *
Student College ID number (G Number) *
Phone Number * ### - ### - ####
Name of High School
*
Parents are welcome to attend!
There are workshops for parents who are interested in learning about the serevices and programs offered. Parents who are planning to attend must also reserve their seat by completiong this section of the form. First Last
Parent's Email
To receive your earliy registration date, you must complete an Orienation, placement test, and meet with a counselor. Please reserve your seat for Orientation and placement test from one of the following dates. you will receive a counseling appointment after completing your assessment test. Please note that the program starts at 4:00p.m. and ends at 7:00p.m. on all the options below:
Tuesday, April 10, 2012 Wednesday, April 18, 2012 Wednesday, April 25, 2012 Wednesday, May 2, 2012
Do Not Fill This Out