Come Back Kids (CBK) Interest Form
Please complete the interest form below to receive information regarding school enrollment. Once the form is completed, you will be contacted to schedule an enrollment appointment.

For more information on earning your high school diploma click here:  https://bit.ly/CBKBrochure
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Email *
First and Last Name *
Other Name (Maiden, nickname, etc.)
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Cell/Main Phone Number *
Email *
Street Address *
City *
State *
Zip Code *
PO Box
City
State
Zip
County *
Last High School Attended:  Include City and State *
Other Previous High School Attended:  Include City and State
Previously attended one.Program? *
Please select which of the school sites below you are interested in attending: *
Required
Please select the most convenient time for your enrollment appointment: *
Are you between the ages of 16-24 and interested to participate in paid work experience? Select “YES” and someone from WorkStartYES will contact you for more info.”
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How did you hear about Come Back Kids?
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