Thompson Extension Academy (TEA) - Student Registration Form (Step 1 of 2)
Please complete ONE registration form for EACH student registering for TEA courses PER school year.

[**Note: the course enrollment form is separate and must be completed for EACH course that EACH student is requesting.**]

Site Facilitator PIN *
Your "online signature" assigned by the TEA Director
Your answer
Student Number *
10-Digit DOE Student Number
Your answer
Student First Name *
Your answer
Student Surname *
Last Name
Your answer
Student Grade Level *
*TEA is currently open to grades 9-12 only*
EntryDate
*for office use*
ExitDate
*for office use*
Enroll Status
*for office use*
Student Date of Birth *
mm/dd/yyyy
Your answer
Home_Phone *
Your answer
Student Gender *
Mailing_Street *
Student's Mailing Address
Your answer
Mailing_City *
Your answer
Mailing_State *
Mailing_Zip *
Your answer
HI_Island *
Regional School *
Not on this list? Please contact TEA Director tea@ethompson.org
Student Email Address *
*email to be used for creating course account, so student must have daily access to this email*
Your answer
Parent/Guardian Name *
Primary Parent/Guardian to contact, if nessesary
Your answer
Parent/Guardian Relationship *
Parent/Guardian Day Phone *
*best number to be contacted, if necessary*
Your answer
Site Facilitator Name *
Your answer
Site Facilitator Title *
(ex: counselor, registrar, teacher, etc...)
Your answer
Site Facilitator Phone *
Your answer
Registrar Name *
Your answer
Parent/Guardian Email *
Your answer
Site Facilitator Email *
Your answer
NOTES:
(any additional information we should know)
Your answer
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