Student Address Information

Address Line 1 *

Address Line 2

City *

State / Province / Region

Zip *

Country *

Previous - Student Information Next - Parent / Guardian Information

Parent / Guardian Information Not Required

Relationship Type *

Prefix

First Name *

Middle Name

Last Name *

DOB *

Gender *
Male Female

Address Line 1 *

Address Line 2

City *

State / Province / Region

Zip *

Country *

Home Phone *

Mobile Phone

Work Phone

Personal Email *

Work Email

Emergency Contact

Previous - Student Address Information Next - Emergency Contact Information Next - Emergency Contact Information

Emergency Contact Information

Emergency Contact's First Name *

Emergency Contact's Last Name *

Relationship Type *

Home Phone

Previous - Parent / Guardian Information Next - Last School Information

Last School Information I have not attended high school

List names of previous schools (Include the cities and states and years attended) *

Last Year Attended High School *

Highest Grade Completed *

Do you have a copy of school transcript(s)? *
Yes No

Has the enrolling student ever had an
IEP? *
Yes No

Does your student currently have a
504 ? * Yes No

Does the enrolling student require ELL (English Language Learner) services?*
Yes No

Previous - Emergency Contact Information Submit Last School Information Next - Workforce Diploma Program

AZ Workforce Diploma Program

Please check this box if you are a participant in the Arizona Workforce Diploma Program

The Arizona Workforce Diploma program requires you to complete 1 class (1/2 a credit) per month. Are you committed to completing 1 class per month? *
Yes No

You are required to make progress in your class monthly. If a student does not work in class for 2 months they will be withdrawn from the Arizona Workforce Diploma Program. *
Yes, I Understand

Weekly contact with your Academic Advisor is required to enroll in the Arizona Workforce Diploma program. Are you committed to weekly contact with your Academic Advisor? *
Yes No

Previous - Last School Information Submit WorkForce Diploma Program

Confirmation

Informed Consent

No student will be considered for enrollment until all necessary documentation is received and student eligibility is verified. Misrepresentation or omission of facts on this application may result in denial or nullification of enrollment. Student also agrees that he/she will meet the monthly course progress requirement, as well as the contact requirements set forth by mentor/teacher/learning plan.

Academic Integrity Policy

I will do my own work. I am aware that all final exams will be proctored. I will not copy another person’s work, in whole or in part, and submit as my own. I will not consult unauthorized material or information during tests unless my teacher gives me permission. I will not plagiarize. I will not copy text, graphics, mathematics solutions, artistic layouts or presentation, or any ideas in any form from another source without proper citation. I will not communicate exam information or answers during or following an exam. I will not provide unwarranted access to materials or information so that credit may be wrongly claimed by others. I will not turn in an original paper or project for more than one different class assignment. I will not, in laboratory situations, falsify or fabricate data or observations, including computer output.

Do you agree? *
I agree I disagree

CONFIRMATION

Media Release Response required *
I agree I disagree

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Type the Signature Name Here *

Previous - AZ WorkForce Diploma Program Submit your Application