Roseville Adult School Citizenship Online Class Enrollment For New Students for Fall
Please complete for fall enrollment of new students. Fall Classes begin the week of Aug 17th. Teacher will contact you regarding class orientation after completing the form.
Email address *
Are you in an Roseville Adult School Citizenship class now? *
Required
Have you taken any classes with Roseville Adult School in the past?
What is your first name? *
What is your last name? *
Gender *
Date of Birth (month, day, year) *
MM
/
DD
/
YYYY
Email *
Phone ( xxx)-xxx-xxxx *
Street Address *
Zip Code, *
City, State *
Emergency Contact: (name and phone) *
Ethnicity *
Race (Mark all that apply) *
Required
Language Spoken *
Years of School *
Highest level of Education completed (Pick one) *
Where did you complete your education? *
Employment (Right now I am) *
Employment Barriers (Mark all that apply) *
Required
Special Programs (Mark all that apply) *
Required
What are your goals? (Pick Two) *
Required
I agree this information is true (type your name) *
Click blue submit button to complete form
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This form was created inside of RJUHSD.