Editing previous response:

Please fix the highlighted areas below before submitting.

Clackamas Middle College Application for Enrollment

Please complete the application below. Required fields marked with an asterisk *

How did you find out about Clackamas Middle College?*

Answer required for "How did you find out about Clackamas Middle College?"

Date:*

Answer required for "Date:"

Student Contact Information

Student First Name*

Answer required for "Student First Name"

Student Middle Initial*

Answer required for "Student Middle Initial"

Student Last Name*

Answer required for "Student Last Name"

Student Date of Birth*

Answer required for "Student Date of Birth"

What grade are you in at your current school?*

Answer required for "What grade are you in at your current school?"

8th

9th

10th

11th

12th

Last/Current School Attended*

Answer required for "Last/Current School Attended"

Last/Current District Attended*

Answer required for "Last/Current District Attended"

Student Home Street Address*

Answer required for "Student Home Street Address"

Student Home City*

Answer required for "Student Home City"

Student Home Zip/Postal*

Answer required for "Student Home Zip/Postal"

Student Phone*

Number Required

Invalid phone number

Student Email *

Answer required for "Student Email "

Invalid email address

1st Parent/Guardian/Caregiver Information

1st Parent/Guardian/Caregiver Name*

Answer required for "1st Parent/Guardian/Caregiver Name"

1st Parent/Guardian/Caregiver Phone*

Number Required

Invalid phone number

1st Parent/Guardian/Caregiver Email*

Answer required for "1st Parent/Guardian/Caregiver Email"

Invalid email address

1st Parent/Guardian/Caregiver Street Address*

Answer required for "1st Parent/Guardian/Caregiver Street Address"

1st Parent/Guardian/Caregiver City*

Answer required for "1st Parent/Guardian/Caregiver City"

1st Parent/Guardian/Caregiver Zip/Postal*

Answer required for "1st Parent/Guardian/Caregiver Zip/Postal"

2nd Parent/Guardian/Caregiver Information

2nd Parent/Guardian/Caretaker (If Applicable) Name*

Answer required for "2nd Parent/Guardian/Caretaker (If Applicable) Name"

2nd Parent/Guardian/Caretaker (If Applicable) Phone*

Number Required

Invalid phone number

2nd Parent/Guardian/Caretaker (If Applicable) Email *

Answer required for "2nd Parent/Guardian/Caretaker (If Applicable) Email "

Invalid email address

2nd Parent/Guardian/Caretaker (If Applicable) Street Address*

Answer required for "2nd Parent/Guardian/Caretaker (If Applicable) Street Address"

2nd Parent/Guardian/Caretaker (If Applicable) City*

Answer required for "2nd Parent/Guardian/Caretaker (If Applicable) City"

2nd Parent/Guardian/Caretaker (If Applicable) Zip/Postal*

Answer required for "2nd Parent/Guardian/Caretaker (If Applicable) Zip/Postal"

Confirmation Email

Answer required for "Confirmation Email"

Invalid email address