Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Franklin MESA Student Enrollment Form
Student Enrollment Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Do you have a current account in the MESA Database, or have you been in MESA in the last 3 years?
*
Yes
No
Not sure, please confirm in Database
First Name
*
Your answer
Last Name
*
Your answer
Middle Name
Your answer
CA SSID
*
You can get this 10-digit number from your counselor, a report card, or ask your Advisor for assistance. Note that an invalid number will not be accepted, so make sure you input your unique ID number.
Your answer
Date of Birth (mmddyyyy)
*
MM
/
DD
/
YYYY
Email
*
Your answer
Mailing Number and Street
*
Your answer
Mailing City
*
Your answer
Mailing Zip
*
Your answer
Phone number
*
Your answer
Grade Level
*
Choose
5
6
7
8
9
10
11
12
Student Gender
*
Choose
Female
Male
Genderqueer / Gender Non-Conforming
Unknown / Decline to State
Other
Ethnicity
*
Choose
African-American/Black
American-Indian/Alaskan Native
Chinese/Chinese-American
East Indian/Pakistani
Filipino/Filipino-American
Japanese/Japanese-American
Korean/Korean-American
Mexican/Mexican-American/Chicanx
Pacific Islander (includes Native Hawaiian, Micronesian, Polynesian, and other Pacific Islanders)
Vietnamese/Vietnamese-American
White/Southwest Asian and North African
Other Asian (Not including Middle Eastern)
Other Spanish-American/Latinx (includes Cuban, Puerto Rican, Central and South American)
More Than One
Other (not listed above)
Unknown/Unavailable/Decline to State
Student Secondary Ethnicity
Choose
African-American/Black
American-Indian/Alaskan Native
Chinese/Chinese-American
East Indian/Pakistani
Filipino/Filipino-American
Japanese/Japanese-American
Korean/Korean-American
Mexican/Mexican-American/Chicanx
Pacific Islander (includes Native Hawaiian, Micronesian, Polynesian, and other Pacific Islanders)
Vietnamese/Vietnamese-American
White/Southwest Asian and North African
Other Asian (Not including Middle Eastern)
Other Spanish-American/Latinx (includes Cuban, Puerto Rican, Central and South American)
More Than One
Other (not listed above)
Unknown/Unavailable/Decline to State
Primary Language Spoken At Home
*
Choose
English only
Spanish only
Asian-language group only
Other non-English only
English and Spanish
English and Asian-language group
Other bilingual
Unknown/Unavailable/Decline to State
Primary Career Interest
Choose
Engineering
Computer Science
Physical Science
Mathematics
Science
Business
Other Math Based Career
Health Profession
Non Math Based Career
Undecided
Secondary Career Interest
Choose
Engineering
Computer Science
Physical Science
Mathematics
Science
Business
Other Math Based Career
Health Profession
Non-Math Based Career
Undecided
1st Parent / Guardian Full Name
*
Your answer
2nd Parent / Guardian Full Name
Your answer
1st Parent / Guardian Phone
*
Your answer
2nd Parent / Guardian Phone
Your answer
1st Parent / Guardian Email
*
Your answer
2nd Parent / Guardian Email
Your answer
1st Parent Guardian Gender
*
Female
Male
Prefer not to say
Other:
2nd Parent Guardian Gender
Female
Male
Prefer not to say
Other:
Clear selection
1st Parent / Guardian Education
*
Choose
Did not graduate from high school
High school graduate only
Some college but no four-year college/university degree
Four-year college/university graduate or higher
Unknown/Unavailable/Decline to State
2nd Parent / Guardian Education
Choose
Did not graduate from high school
High school graduate only
Some college but no four-year college/university degree
Four-year college/university graduate or higher
Unknown/Unavailable/Decline to State
Next
Page 1 of 2
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
