Editing previous response:

Please fix the highlighted areas below before submitting.

YJC Site - Enrollment Interest Form

Please fill out this form if you are interested in enrolling at YouthBuild Charter School of California's site at the Youth Justice Coalition. Required fields marked with an asterisk *

Contact Information

First Name*

Answer Required

Last Name*

Answer Required

Email Address*

Answer Required

Phone Number*

Number Required

How would you like us to contact you?*

Answer Required

Phone Call

Text

How old are you?*

Answer Required

What is your zip code?*

Answer Required

Is there anything you'd like to share with us about why you want to enroll at the YJC?

Answer Required

Confirmation Email

Email Required