Chaffey College Interest Form

Contact Information

First Name

Last Name

Personal Email Address

(not your high school email address)

Confirm Email Address

Telephone

Permission to send text?

Cell Phone Provider

Grade Level

Birth Date

Street Address

City

Zip Code

State

I am not currently attending high school

High School

School Name or City (full or partial) In order to search by name, enter at least 3 characters of the name. Country

Unlisted School Name and Address

Home Schooled

Do you have an IEP or 504 plan?

Have you ever been in court-ordered foster care?

Are you a F1 Visa International Student?

Are you interested in Chaffey Athletics?

Anticipated Entry Term:

What academic and career community interest you?