Summer Pursuit Lab 2021 Pre-Registration Form
Our Winter Workplace Readiness & Work-Based Learning Session (2 classes to choose from): July 12th - Aug 12th, Monday-Thursday 2 hours a day 10:00-12:00pm for Section C100 or  SAME dates/days but from 12:30-2:30pm for Section C200, Early bird Registration to reserve a seat is June 18th, and absolute Final Deadline for this form is July 2nd! (If you still want to register after then please email pursuit@edcc.edu)
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Email *
First Name (offical/legal) *
Last Name (offical/legal) *
Date of Birth (of student) *
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The student named above meets the following requirements for the provision of pre-employment transition services:                                                                                   1. Is between 16 years of age and 21 years of age;         2. Has a documented disability (an IEP, a 504 eligibility, or a medically documented disability). *
Phone Number (may add home, cell, and alternative) *
Emergency Contact  Name & Phone Number (may add home, cell, and alternative) *
What time of day would work better for to take this class? (CLICK ALL THAT APPLY) *
Required
If possible we will try to, but would you feel safe and okay for in person class at the Edmonds College campus for these daily class time? If so mark ALL the times you are able to do IN PERSON. *
Required
MAILING ADDRESS (INCLUDE CITY, STATE, AND ZIP CODE) *
STUDENT ID NUMBER AND  High school name               if no longer in a high school, say which high school and when you graduated. *
GENDER *
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