High Sierra Energy Summit/HOME
REGISTER FOR CLASSES
Please fill out all fields with asterisks(*). Without complete information we will be unable to register you.
*Name:
Date of Birth:
*Permanent Residency Address:
Number/Street (Do not use PO Box):
City:
State:
Zip Code:
Mailing Address While Attending College
(if different than above):
Number/Street (Do not use PO Box):
City:
Zip Code:
*Day Phone:
*Email:
Is English your primary language?
Yes
No
Education Status:
Please indicate your education status. under penalty of perjury, SELECT THE HIGHEST LEVEL OF EDUCATION COMPLETED:
Not a High School Graduate
High School Graduate without College Degree
College Degree
Year of Highest Education Level
Enter the year in which the highest level of education was completed or certificate received (YYYY):
Principal Educational Goals (describe briefly):
Four-year College Plans:
If you plan to transfer to a four-year college, please select one:
California State University
University of California
Private College in California
Out of State College
Undecided
High School Information (last High School attended):
Name:
County:
Or out of state:
Last College Attended:
Tell briefly why you are interested in attending the High Sierra Energy Summit:
Family Education and Privacy Act
The college receives inquiries from a variety of persons and agencies requesting directory information. This includes name, address, telephone number, major dates of attendance, degrees and awards earned, participations in official college activities and sports.
Do you authorize the release of this directory information?
Yes
No
Signature (full name):
Date:
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