Enrollment Interest Form

Enrollment Interest Form
Contact Information
Name

First NameLast Name
Select the option that best applies to you

Other
If you selected "other" in the question above, please describe:
What pronouns do you use? (So we know how to address you/ refer to you in our communications.)

Other
What is your email address?
example@example.com
What is your phone number?
Please enter a valid phone number.Format: (000) 000-0000.
What is your preferred method of communication?
What is your preferred language for communication?
Potential Student's Information
If you are filling out this form on behalf of a potential student, what is the student's name?
Student's Age:
Students must be between ages 15-30 to enroll, and some sites require a minimum age of 18.
Student's Zip Code:
Does the student already have a high school diploma?
Select the option that best fits. How long has the student been out of school? (If the student is currently enrolled at another school, please select the first option.)
Site/Program Preference: Please select your preferred option from the list of our program partners/sites below. If you are unsure, you may leave it blank.
You may select multiple options. Refer to the map below to see where each program/site is located.
Use the map below to find program/site locations near you. Zoom in and out using the + and - buttons in the lower left. Click on the blue icons to see the site name and information.
Check if any of the following apply (leave blank if none apply.)
Our YouthBuild and workforce program partners offer a variety of different job training, work experience, and college readiness opportunities. Check any that may be of interest to the potential student (not all programs offer the options below):

Other
As a community school, we partner with other community organizations and programs to provide additional resources to our students and community members at some of our school sites. Check the boxes below if you are interested in any of the following community resources (not all options are available at all sites):

Other
Additional Information
How did you hear about YouthBuild Charter School of California?
If you have any questions for us or want to provide any more details about yourself, you may include them below.
Should be Empty:

Enrollment Interest Form

Contact Information

Potential Student's Information

Additional Information