Transfer Prep Day Registration Question Title * 1. Student's First Name: Question Title * 2. Student's Last Name: Question Title * 3. Student's E-mail Address: Question Title * 4. What is the ethnicity of the student? African-American/Black American-Indian/Alaskan Native Chinese/Chinese-American East Indian/Pakistani Filipino/Filipino-American Indian Japanese/Japanese-American Korean/Korean-American Mexican/Mexican-American/Chicano Pacific Islander Vietnamese/Vietnamese-American White/Caucasian Other Asian (Not including Middle Eastern) Other Spanish-American/Latino Other (please specify): Question Title * 5. What is the gender of the student? Male Female Question Title * 6. Are you a current EAOP participant? Yes No Question Title * 7. Student's High School: Arlington High Canyon Springs High Carter (Wilmer Amina) High Citrus Hill High Colton High Eisenhower High Fontana High Kaiser High La Sierra High Norte Vista High North (John W.) High Perris High Rancho Verde High Riatlo High San Jacinto High Sherman Indian High Valley View High Vista Del Lago High Other (please specify): Question Title * 8. Do you belong to any of the following Community Based Organizations? BLU Council of African American Parents (CAAP) San Bernardino Independent Living Program (ILP) Seventh Day Adventist Church Heritage N/A Question Title * 9. Student's home phone number: Question Title * 10. If available, student's cell phone number: Question Title * 11. If a parent or guardian is also attending the event, please provide the following information. Name (First and Last): Relationship to Student: Phone Number: E-Mail Address: Question Title * 12. Please specify if the student or parent/guardian need special accommodations due to a disability. Yes No If yes please specify Question Title * 13. Please indicate any food allergies or special dietary needs of student or parent/guardian. If none, type n/a. Question Title * 14. Please select a lunch preference. Student Ham Sandwich Turkey Sandwich Veggie Sandwich N/A Student menu Parent Ham Sandwich Turkey Sandwich Veggie Sandwich N/A Parent menu Next
