PHARMACY TECH Student Registration
Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Phone Number *
Additional Phone Number (optional)
Date of Birth *
MM
/
DD
/
YYYY
STUDENT Email *
Are you in any Specially Funded Programs?
Clear selection
Cohort Registered *
NOTES:
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of LAUSD.

Does this form look suspicious? Report

Google Forms