Silver Valley Adult School Registration
Please complete all required fields to register for the Silver Valley Adult School. If you have any questions, issues, or concerns, please contact the Alternative Education Center at (760) 254-2715.
Email *
Enrollment Year *
First Name *
Middle Name
Last Name *
Maiden Name (if applicable)
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Phone Number *
Secondary Phone Number *
Emergency Contact Information (Name, Relationship, Phone Number) *
Address Line 1 (street number and name) *
Address Line 2 (if applicable)
City *
State *
Zip Code *
Mailing Address (if different from physical address)
Primary Language Spoken *
Native Language *
Ethnicity: Do you consider yourself to be of Hispanic/Latino origin? *
What is your race? (select one or more) *
Required
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