Registration Form

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Date of Birth*

Answer Required

Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Phone*

Number Required

Alternative Phone (if applicable)

Number Required

Email 1*

Answer Required

Ethnicity*

Answer Required

Hispanic or Latino

Not Hispanic or Latino

Race

Answer Required

Last School Attended*

Answer Required

Last Year Attended and grade or degree/certification*

Answer Required

Classes Interested In. Check all that apply.*

Answer Required

High School Diploma

GED

National External Diploma Program

Adult Basic Education

English as a Second Language

Fire Science

Paraeducator

Do you need a Chromebook to use during your enrollment with us? For example, to work on your high school diploma, the coursework for office occupations, or to get your OSHA 10 certification in construction.*

Answer Required

Yes

VOLUNTARY AUTHORIZATION

TO SHARE SOCIAL SECURITY OR ITIN NUMBER

PURPOSE: This allows Feather River Adult School to collect your social security number and share it with the California Department of Education who will share your personal information with the Employment Development Department. The Employment Development Department is the state agency responsible for maintaining personally identifiable information. It keeps all information confidential it receives from the California Department of Education for use only to track the labor market outcomes of adult education program participants in compliance with all applicable state and federal laws and mandates.

If you provide your number, EDD will look for information quarterly for a year.

If you wish not to provide your number at the time of registration, FRAS will contact you quarterly by email, text, or phone to answer the following:

1) Are you attending school in a different area?

2) If yes, what school do you attend now?

3) Do you have a job now?

4) If yes, How much do you earn usually in a month?

PLEASE READ THE FOLLOWING CAREFULLY

I understand that I do NOT need to provide a Social Security/ ITIN Number to take classes at this school.

Response*

Answer Required

YES. I will voluntarily provide my Social Security or ITIN

NO. I choose not to provide a Social Security Number or ITIN

I do not have a Social Security Number or ITIN

SS# - if providing

Answer Required

Are you attending a different school?*

Answer Required

Yes

If yes, what school do you attend now?

Answer Required

Do you have a job now?*

Answer Required

Yes

How much do you earn usually in a month? Best estimate... If unemployed please put 0.00*

Answer Required

PERMISSION FOR RELEASE OF RECORDS

By my signature the end of the form, I give ongoing permission to Feather River Adult School to release information regarding my attendance and academic performance at said school.

Permission is given to the following individuals and/or organizations:*

Answer Required

MEDIA RELEASE

One of the things that we take great pride in at our schools is our efforts to share important information with our stakeholders in a variety of ways. Not only will we use traditional tools—newsletters, phone calls, local papers, and websites—to keep you posted about everything happening in our schools, we may also use social media services like Facebook. We hope to develop stronger partnerships with the community we serve by joining you in these digital spaces. We also like to celebrate the successes of our students in all of our communications. We want to praise students who are doing remarkable things in and beyond our classrooms. We believe that we build stronger communities when we take the time to spotlight the positive work our children do. Understandably, however, we want to respect your right to privacy. As a result, we’d like to know which of the following practices you give us permission to use in our school-based communication efforts.

Check all That Apply*

Answer Required

CLIENT NAME: I give permission for my first and last name to be used in any school-based communications —like newsletters, websites, articles for local papers, television programs, and posts to school-monitored social media spaces—that school or district employees generate.

CLIENT PICTURE: I give permission for my picture to be used in any photos or video clips the school or district employees generate for school-based—like newsletters, websites, articles for local papers, television programs, and posts to school-monitored social media spaces.

GROUP PICTURE ONLY: I give permission for my picture to be used in any school based communications only when part of a larger group

I do not give permission for my name or picture to be used in any school-based communications.

Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Registration Form