Dakota County Area Learning School-Application for Enrollment
Student First Name *
Your answer
Student Last Name *
Your answer
Gender *
Required
Date of Birth *
Your answer
Father's Full Name *
Your answer
Mother's Full Name *
Your answer
Name of Parent/Guardian(with whom you reside) *
Your answer
Home Address(Street, City, State, Zip) *
Your answer
Home Phone Number *
Your answer
Student Cell Phone Number *
Your answer
Parent E-mail *
Your answer
Father's daytime number *
Your answer
Father's Cell number *
Your answer
Mother's daytime number *
Your answer
Mother's cell number *
Your answer
Program Participation of Interest *
Required
Current/Home High School *
Your answer
Current Grade *
Your answer
Resident School District *
Your answer
Receiving Special Ed Services *
Special Ed Case Manager *
Case Manager must send copy of current IEP
Your answer
Applicant Signature *
By typing your name you are submitting this application for consideration of enrollment
Your answer
Parent/Guardian Signature(if student is under 18 years of age) *
By typing your name you are submitting this application for consideration of enrollment
Your answer
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