EmailMe Form - Delta Charter Schools -- Inquiry Form

Select county of residence *

School of Interest

Student grade level *

Contact Information:

Parent/Guardian Name *

First Last

Primary Phone *

### - ### - ####

Alternate Phone

### - ### - ####

Email

If you do not have an email address, please call Dawn at (209) 830-6363.

Street Address

City

Zip

Student Information:

Student Name *

First Last

Student DOB *

MM / DD / YYYY

Last school student attended *

Is the student a foster youth? *

Yes

No

If yes, please enter caseworker name and telephone number.

Required documents for registration interview

*Birth certificate

*Immunization record

*Evidence of TDAP or informed waiver (7th grade and above)

*Transcript for high school students

*Attendance history

*Discipline record

Proof of residence if permanent housing (utility bill)

Check next to each item to acknowledge you will bring the required documentation to a registration interview.
*Appointments without these documents must be rescheduled.

Comments/Questions

Survey Questions:

Have you attended an
Information Night?

Yes

No

How did you hear about our schools?