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Enrollment Form
Please complete all fields of the form. Once your enrollment has been reviewed and approved, you will receive an email confirmation.
If you have any questions, please send email to
aescalera@mail.fresnostate.edu
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* Indicates required question
Email
*
Your email
Student Information
First Name
*
Your answer
Last Name
*
Your answer
Address, City, Zip
*
Your answer
Phone (000-000-0000)
*
Your answer
Email Address
***Please
DO NOT
use your student email address***
*
Your answer
Student ID
*
Your answer
Grade Level
*
9
10
11
12
Gender
*
Male
Female
Other
Decline to State
Ethnicity/Race
*
American Indian
Asian
African American
Hispanic
Native Hawaiian or Other Pacific Islander
White, Non-Hispanic
Multi-Racial
Other
Decline to State
Which of the following area(s) do you have interest in teaching?
(Check all that apply)
*
Special Education
Elementary (K-6)
Middle School (7-8)
High School (9-12)
Required
**Only Answer if you selected
High School (9-12)
** Which subject area are you interested in teaching at the high school level?
Math
Science
Other:
High School Information
School Name
*
Choose
Buchanan
Clovis High
Clovis East
Clovis North
Clovis West
Name of High School Counselor
*
Your answer
What is the title of the Education Pathway class you are enrolled in?
(e.g. Grade 11 - Careers with Children)
*
Your answer
Who is your Education Pathway teacher?
*
Your answer
Who is your current GPA?
*
Your answer
Parent/Guardian Information
Parent Name (First Last)
*
Your answer
Parent Phone (000-000-0000)
*
Your answer
Parent Email Address
(Cannot be the same as student email)
*
Your answer
Send me a copy of my responses.
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