Secondary Enrollment Form

First Name
Last Name
Gender	Male Female
Date of Birth
Father's Name
Mother's Name
Name of Parent/Gaurdian you live with
Home Address Include Street, City, State, Zip Code
Home Phone
Student Cell
Parent Email
Father's daytime number
Father's Cell
Mother's daytime number
Mother's Cell
Program Participation	On-line / Independent Study DCALS Main DCALS North
Current High School
Grade
Resident School District
Receiving Special Ed Services
Special Education Case Manager
I plan to attend a group enrollment meeting on:	Aug 27 Sept 17 Oct 8 Oct 29 Nov 26 Dec 17 Jan 14 Feb 4 Feb 25 Mar 17 April 14 May 5 (Seniors Only)
I am unable to attend a group meeting, please call me.	Yes