Welcome to Julian Charter School

Student's Legal First Name
Student's Legal Middle Name
Student's Legal Last Name
Gender	Select? M F
Date of Birth	January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Grade student will enroll in for 2013-2014 school year	0 1 2 3 4 5 6 7 8 9 10 11 12 Enter 0 for Kindergarten
Street Address Line 1
Street Address Line 2
City
State	Select? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
County	Select? San Diego Orange Imperial Riverside
Program	Select? 1:4 INSITE OL (Online Learning) HS (Home Study) MIS (Modified Independent Study) MIS INSITE
School District of Residence
Last School Attended
Parent/Guardian Name
Primary Phone
Secondary Phone
Email Address Information Concerning JCS will be sent to
Does the student have Internet Access?	No Yes
Does the student have an IEP or 504?	Select? None IEP 504
Has the student been Suspended or expelled?	Select? None Suspended Expelled
If Student was Suspended or Expelled, what was the reason?
Has the student Ever been Home Schooled before?	No Yes
How did you hear about JCS?	Select? Friend EF Sibling JCS Web Page Google District Signage Other
Why are you choosing JCS over other schools?	Select? Choice Academic Social Health Extracurricular Activities Expelled
Notes
What is the opposite of bad?	(This question helps prevent nefarious web creations, automatons, and sundry from wreaking havoc on our stuff...because although machines can read....unlike you, they cannot understand...yet)
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Once your Admission Questionnaire is submitted, a representative will contact you within 2 business days. Thank you for your interest in JCS!

IMPORTANT: Completing this form does NOT register or enroll the student with Julian Charter School. This is a necessary and preliminary step in that process.

Admissions