GBCS N4th 2024-25 High School Lottery Online Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Once your application is complete, please take the following steps.
1. NEW STUDENTS: After finishing application, please attend Gordon Bernell campus on 2821 4th Street NW, Albuquerque, NM 87107 to attend orientation the following Monday after filling out or call the school at 505-916-8618 to get the exact dates.

2. RETURNING STUDENTS: Show up to 2821 4th Street NW to speak to your advisor and fill out new contact information page for this new school year.

Email *

Today's Date *

YYYY

Student Name: (First, Middle and Last)
*

If student has gone by any other legal name please list below.

Student Physical Address:
*

Student Mailing Address if different than Physical Address

Student Date of Birth:
*

Person completing this form
*

Student/Self (only if over 18)

Parent/Guardian

Other:

Required

If student is under 18, please provide parent/guardian name and contact information. Please include: Physical address, city, state and phone numbers. If this does not apply, enter N/A.
*

Name of emergency contact: What relationship to the student: phone number: physical address, city and state
*

Student Phone Number (include area code):
*

Secondary Phone Number (include area code), Name of person and relationship:
*

Ethnicity
*

Hispanic

Non-Hispanic

Race *

Asian or Pacifi c Islander

Black or African American

White or Caucasian

American Indian or Alaskan Native

Other: (please indicate)

If American Indian or Alaskan Native, please specify tribe:

What is the last school you attended? (include city and state)
*

What is your primary language?

English

Spanish

Other

Clear selection

Gender

Female

Male

Clear selection

Clear form

Never submit passwords through Google Forms.

This form was created inside of Gordon Bernell Charter school.

Does this form look suspicious? Report

Forms