Gonzales Adult School: Full Student Registration
Event Timing: Spring 2021
Event Address: Virtual Classroom
Contact us at
‪(831) 290-0105‬ (Distance Learning Line) or adulted@gonzales.k12.ca.us
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Email *
Student Status
Clear selection
First Name *
Last Name *
Gender *
DOB *
MM
/
DD
/
YYYY
Mailing address *
City *
Phone Number *
Highest year of school completed: *
If you attended high school, what is the name & city of the high school?  What year did you last attend?
Highest Diploma earned *
Earned in the U.S.? *
Did you have an IEP or 504 in which you received additional services/accommodations to your learning plan? *
Ethnicity *
Race *
Native Language *
Employment Barriers (Mark all that apply): *
Required
Goals- My educational goal for this program year is to: *
Required
My other goal for this program year is *
Required
Labor Status *
Required
Public Assistance Status *
Required
What class/es would you like to register for?
Please list the class, workshop, or certification you wish to take if it was not listed above.
How comfortable to do you feel using a smartphone? *
Not comfortable
Very comfortable
How comfortable do you feel using a computer or tablet? *
Not comfortable
Very comfortable
Which of the following devices do you have access to at home? *
Required
Income Level: (Max annual household income, including public assistance) Yearly Income *
Family size
Number of K-12 students in the home. If so, which school(s).
Choose one: *
Are you currently enrolled in another educational institution?
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Outreach: How did you hear about our program? *
Required
There will be times throughout the school year where we would like to take pictures or videos of our class sessions or activities for the purposes to promote our school. With that said, Gonzales Adult School is requesting your permission to reproduce, through audio or visual means, your image while actively participating in activities related to this educational program. Note these pictures or videos may be published on our website, our social media page, or flyer with the sole purpose of advertising our school. *
Student Signature: Please type you name:: Hold Harnless Policy: Applicant agrees to defend, indemnify and hold harmless the (DISTRICT), its Board of Trustees, offices, employees, and agents from any and all legal losses or injuries arising from, or allegedly arising from, the negligence of the applicant, its employees and/or agents while attending classes and/or class activity.
Are there any other services we don't provide but is needed in our community?
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