Young Scholar Registration Form

Term

Summer 2024

Fall 2024

First Name - please DO NOT use any nicknames

Preferred Name (if different than legal)

Last Name

Birthdate

Gender

Female

Male

Phone number

Social Security Number

Ethnic background (please check only one)
Are you Hispanic or Latino?

Yes

No

What is your racial background? (please check one or more)

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Confirm Email Address

Current School

CEEB Code

Guidance Counselor

Guidance Counselor Email

Guidance Counselor Phone Number

Graduation Year

Please list the courses you wish to take this semester as well as alternate courses. In the event that we cannot register you for your first choice, we will try to register you for your alternate choices. Thank you.

Class #1

Title #1

Credits #1

Days #1

Class #2

Title #2

Credits #2

Days #2

Please list up to (3) alternates.

Alternate #1

Alt Title #1

Alt Credits #1

Alt Days #1

Alternate #2

Alt Title #2

Alt Credits #2

Alt Days #2

Alternate #3

Alt Title #3

Alt Credits #3

Alt Days #3