Golden Valley Adult Education Registration Form for High School Diploma Students

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The CA Department of Education Requests demographic data for all adults who enroll in classes. This information will ONLY be used to comply with state and federal funding requirements and will remain confidential.

Please fill out the following information for enrollment.

Email *

First Name *

Middle Name

Last Name *

Date of Birth *

YYYY

Gender *

Address *

City *

State *

Zip Code *

Phone Number- Please include your area code. *

Alternate Phone Number- Please include your area code.

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