DAY PROGRAM APPLICATION

Genderrequired

Students must be over the age of 16 in order to apply at One Bright Ray Community High School

Address Where Student Lives

Staterequired

Check here if the Mailing Address is different

Scholastic

Student's Current Grade Levelrequired

What is the name of the last high school the student attended?required

Based on your answer, student transcript(s) MUST be submitted online or in person to determine eligibility.

Recent Student Transcript(s)

Does your student receive Special Education services (IEP)?required

A current copy of an IEP must be submitted either online or in-person to determine student eligibility.

IEP

Which OBR Campus is the student applying to attend?required

Which OBR Campus is the student applying to attend? (#2)required

Which OBR Campus is the student applying to attend? (#3)required

Error: You must not select the same campus twice. Please select unique values.

Race

Choose one or more:

Race(s)required

Parent/Guardian Information

Student primarily lives withrequired

Mother

Father

Other Parent/Guardian

Relationship to Studentrequired

Check here if you would like to add an additional contact

Other Parent/Guardian - Emergency Contact

Relationship to Studentrequired

Check here if you would like to add an additional contact

Other Parent/Guardian - Emergency Contact

Relationship to Studentrequired

Contact Information

Please list the e-mail addresses below that you would like communications sent to in order of importance.

Additional Information

If you wish to provide any more documentation during this Intake Application, please use this upload field here.

Additional Documents

Referral Sourcerequired

Electronic Signature

The electronic signature below, and all of its related fields, replaces a handwritten signature on paper and is legally binding.

I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature below and its related fields are treated by like a handwritten signature on a paper form.

Parent/Guardian Signature

I Agreerequired

Student Information

Address Where Student Lives

Mailing Address

Scholastic

Race

Parent/Guardian Information

Mother

Father

Other Parent/Guardian

Other Parent/Guardian - Emergency Contact

Other Parent/Guardian - Emergency Contact

Contact Information

Additional Information

Electronic Signature

Parent/Guardian Signature

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