Pittsburg High School STS Academy Drivers ED Sign-Up Form

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Email *

Record my email address with my response

Student Email *

PERSONAL EMAIL. NOT SCHOOL EMAIL

Last Name *

First Name *

Student ID # *

Which High School are you affiliated with?

PHS

BDHS

Clear selection

Birthdate *

Must be 15 1/2 years of age in order to sign up for program.

YYYY

Grade Level *

9th Grade

10th Grade

11th Grade

12th Grade

Race/Nationality *

White

Black or African American

Hispanic/Latino

Asian

Native Hawaiian or Pacific Islander

American Indian or Native Alaskan

Multi-Racial

Declined to State/Unknown

Other:

Student Phone number *

We prefer cellphone as we will text updates to the number listed.

Parent/Guardian Phone number

Parent/Guardian Email

Address *

Select Dates(click all that apply) *

Please select the time frame you would like to be in the class. If you select multiple sessions you will be placed in the first available session based on the date you submitted your application. Class may be accessed from campus or remotely

MAKE UP/INCOMPLETE CLASS

May Session(May 6-May 31)

SUMMER SESSION (TBA-Check your email after June 1 for Dates)

Required

Student Electronical Signature *

By signing below, I certify that I am a student currently enrolled in the Pittsburg Unified School District and I will participate and attend to the best of my ability in the after school tutoring sessions and/or after school program. I also understand that any misconduct on my part while participating/attending in the after school program are terms of withdrawal and termination of the program.

*PLEASE SIGN WITH YOUR FULL LEGAL NAME*

Parent/Guardian Electronic Signature *

I have given my permission for the above name child to actively participate in this program. *PLEASE SIGN WITH YOUR FULL LEGAL NAME*

Certificate Distribution Info (Student Signature) *

Once you complete your final exam, It takes 7-10 business days for certificates to be delivered to STS Academy. From there, they will be distributed to the students from Pittsburg High School. A REMIND message will be sent out once the certificates are ready to be picked up. If you require a duplicate certificate, there will be a $20 fee for a replacement. Please *SIGN WITH YOUR FULL LEGAL NAME* if you understand and agree to this policy.

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