DHS New Student Questionnaire and Assurance Forms 
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Demographic & Background Information
Date/Fetcha *
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Student ID# *
If you are not coming from Santa Maria HS, Pioneer Valley HS, or Righetti HS Please Write "999999" for this answer.

Student Name *
Student Last Name *
Student's Preferred Name or Nickname
Student's Mobile Number *
Guardian's or Caretaker's Full Name *
Guardian's or Caretaker's Phone Number  *
Home School (Last School Attended) *
How do you normally get to school? *
Do You Work? *
If you do work, what is your job or the work you do? *
Does the money you earn help pay for expenses in of maintaining your household? *
Do you provide care for siblings, family, or others in your household? *
What duties do you have in taking care of your family and the household? *
What are your Career Goals?
What are your hobbies and interest?
Are you a Foster Youth (have been removed from your home, in temporary custody, or have violated the law? *
Do you share housing with others to help meet or ease living expenses? *
(live in home with multiple families, an aunt and/or Uncle, Grandparent, or other persons who could be considered an additional provider of household income?)
Do you lack a fixed, adequate, and, regular nighttime address? *
Do you sleep in the same house every night or do you have to change houses for reasons other the having separated parents?
Do you live in inadequate housing? *
Are you living in Motels, RV Parks, Campgrounds, tents, cars, parks, unsafe housing, housing without basic utilities, bus or train stations, or over-crowded homes, 
Have you gone to Juvenile hall and/or attended a juvenile court school and have transferred anytime after having completed your 2nd year of high school?
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Is one of your Caretakers or Guardians a member of the military and you've had to transfer schools any time after having completed your second year of high school?
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Are you a member of a family where one of your caretakers or guardians work as a migrant worker and have had to move multiple times to follow work? *
Do You have a Child or are you expecting a child soon?
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Assurances & Disclosures
The following questions and statements are meant to inform you of your rights, responsibilities, and obligations as a student attending Delta High School. After reading each item and stating that you understand, you will be asked to Type your name in a space provided below to indicate that you understand and agree to follow the guidelines given for enrollment.
My Family and I have met in person with my Counselor/Admin to discuss placement at Delta HS *
I understand that going to Delta HS is my choice and that this is a voluntary placement. *
I understand Delta HS does not offer A-G, College Prep Program; although, Delta does offer AHC College Now! courses and CTE Certificate options. *
I understand that district transportation may be available; but is not guaranteed, and I am responsible for getting to school even when it is not provided. *
I understand that Delta is a three hour day program with two sessions, and I may not get to choose a session as it will be based on seats available and coursework needed. *
Required
I understand that I will not be allowed to participate in any CIF sports programs while I am enrolled at Delta HS  *
although, I can participate in intermural sports and other activities that may provided at Delta.
I understand I will not be allowed to participate in my Home School's student activities will enrolled at Delta HS (ex. Grad Night and Graduation).  *
However, I can go to dances and games if I meet the requirements to be in good standing
I understand that if I want to return to my home school during one of the allocated time periods, I must meet the necessary criterion to be in good standing and eligible for a recommendation for approval or my application to return. *
The criterion to be eligible for return are: Achieve 90% attendance (ADA) or better, demonstrate academic achievement through grades and credit completion, be able to graduate on time based on Comp School's credit expectations (requirements vary upon date of return), and maintain a clean disciplinary record.
I understand that If I want to submit an application to return to my home school for the spring semester of the current school year, that I must submit my application and have a Meeting with my parents (if under 18) and the school counselor to discuss the transfer and sign needed documents to authorize the transfer before the first Friday in December.

*
I understand that If I want to submit an application to return to my home school for the Fall semester of the Following school year, that I must submit my application and have a Meeting with my parents (if under 18) and the school counselor to discuss the transfer and sign needed documents to authorize the transfer before the Last Friday in May.

*
Student Statement *
Please provide a brief response to the following statement starter: "I would like to come to Delta HS because:"
Preferences and Options
Preferred Session *
Are you currently enrolled or planning to enroll in CTE classes at SMHS, PVHS, or RHS *
CTE Certificated Courses *
CTE Pathways are a year long commitment! To participate in CTE, you will need to attend Delta AM session and CTE PM session (5th/6th Periods) If Interested, indicate you choice(S) 
Required
College Now Courses *
College Now Classes include class like Welding / Media arts / STEM & several other options College Now Program Information 
Clubs/Activities *
Required
Graduation Goals/Plans *
These are just your initial goals. It is okay to change them as you go along!
By typing your first and last name in the space provided, you are indicating that you have reviewed and agree to the terms and assurances listed above. *
Anything else you would like us to know to help us plan a good schedule for you:
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