WCSA Waipahu/Kapolei Student Intake Form
Please complete this form in its entirety. Once submitted, the school will contact you to complete the registration process.
Last 4 digits of Social Security Number (XXX-XX-_ _ _ _)
A school official will contact you to verify your information.
Legal Last Name *
Legal First Name *
Middle Initial
Maiden Name (If applicable)
Mailing Address *
Street Address
City *
Zip Code *
What is your First/Home Language (ie. English, Spanish, etc.)
Primary Phone *
Phone number you wish to be contacted at.
Primary Phone Number *
Include area code (e.g. 999-999-9999)
Secondary Phone *
Provide another phone number you can be reached at.
Secondary Phone Number
Include area code (e.g. 999-999-9999)
Work Phone
Include area code (e.g. 999-999-9999)
Email Address *
Birthdate *
MM
/
DD
/
YYYY
Age *
Gender *
Select the location you are registering for *
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