Registration Form

First Name*

Answer required for "First Name"

Middle Name

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Phone*

Number Required

Alternative Phone (if applicable)

Number Required

Email 1*

Answer required for "Email 1"

Ethnicity*

Answer required for "Ethnicity"

Hispanic or Latino

Not Hispanic or Latino

Race*

Answer required for "Race"

Last School Attended*

Answer required for "Last School Attended"

Last Year Attended *

Answer required for "Last Year Attended "

Highest Diploma Or Degree Earned*

Answer required for "Highest Diploma Or Degree Earned"

Classes Interested In. Check all that apply.*

Answer required for "Classes Interested In. Check all that apply."

Portola Construction is FULL. Still taking registration for waitlist and interest for next offered class.

English as a Second Language

Adult Basic Education

High School Diploma

National External Diploma Program

GED

Fire Science is FULL. Still taking registration for waitlist and interest in next offered class.

Paraeducator

Quincy Welding is FULL. Still taking registration for interest for next offered class.

How did you hear about our school? (Check all that apply)

Answer required for "How did you hear about our school? (Check all that apply)"

Website

Family or Friend

Social media

Other:

Have you ever taken an online (remote) class? *

Answer required for "Have you ever taken an online (remote) class? "

Yes

Do you prefer to learn online (remote), in-person, or both (hybrid)?*

Answer required for "Do you prefer to learn online (remote), in-person, or both (hybrid)?"

Online (remote)

In-person

Both (hybrid)

What do you use for online learning? (Check all that apply)*

Answer required for "What do you use for online learning? (Check all that apply)"

Cell Phone

Tablet

Laptop/Computer/Chhromebook

Do you share this computer, laptop, tablet, or phone with others?*

Answer required for "Do you share this computer, laptop, tablet, or phone with others?"

Yes

How do you connect to the internet? (Check all that apply)*

Answer required for "How do you connect to the internet? (Check all that apply)"

Through my phone

Wifi/Internet connection in my home

Personal Hotspot

WiFi in the community

WiFi at school

Other

Do you have reliable and affordable internet at home? *

Answer required for " Do you have reliable and affordable internet at home? "

Yes

No, it is too expensive right now

No, it usually doesn’t work

No, it is too slow to use

Do you need a Chromebook to use during your enrollment with us to complete your coursework?*

Answer required for "Do you need a Chromebook to use during your enrollment with us to complete your coursework?"

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 for "Response"

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# or ITIN - if providing

Answer required for "SS# or ITIN - if providing"

Are you attending a different school?*

Answer required for "Are you attending a different school?"

Yes

If yes, what school do you attend now?

Answer required for " If yes, what school do you attend now?"

Do you have a job now?*

Answer required for "Do you have a job now?"

Yes

If you answered "no" to having a job now, are you?

Answer required for "If you answered \"no\" to having a job now, are you? "

Retired

Unemployed

Employed w/ notice

Not in labor force

How much do you earn usually in a month? Best estimate... please put $0 If unemployed or not in labor force. *

Answer required for "How much do you earn usually in a month? Best estimate... please put $0 If unemployed or not in labor force. "

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

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 for "Check all That Apply"

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