Mid-City Site Enrollment Interest Form

Interested in enrolling at YouthBuild Charter School of California's Mid-City site located at 4103 West Adams Blvd? Fill out this form and we will be in touch with you!

Contact Information

First Name*

Answer required for "First Name"

Last Name*

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Select the option that best applies to you.*

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I'm a potential student looking to enroll.

I'm a parent/guardian of a potential student looking to enroll.

I am a counselor/social worker/advocate of a potential student looking to enroll.

I am a parent, family member, or community member looking for resources

Other:

What pronouns do you use?

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He/Him

She/Her

They/Them

Other:

If you are filling this out on a potential student's behalf, what is the student's name? (Leave blank if you are a potential student filling this form out for yourself.)

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What is your email address?*

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What is your phone number?*

Number Required

What is the age of the student looking to enroll?*

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What is your preferred method of communication?*

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Phone Call

Text

How did you hear about YouthBuild Charter School of California?*

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If you have any questions for us or want to provide any more details about yourself, you may include them below.

Answer required for "If you have any questions for us or want to provide any more details about yourself, you may include them below."

Please fix the highlighted areas below before submitting.

Mid-City Site Enrollment Interest Form