GtC Application

Please complete and submit this form and we will respond via e-mail within 3 working days.

Fields with the red * are required.

Eligibility Guidelines

Applicants must meet the following eligibility requirements, per the GtC Academy charter authorized through LEA Petaluma City Schools:

16-20 years old
Resident of the state of California

SRJC Student ID Number (if you have one)

Last Name *

First Name *

Your preferred Gender Identity Pronoun (e.g. She/He/Ze/They/Other) *

Date of Birth *

Month

Day

Year

How old will you be on January 7, 2019? *

Phone number (XXX) XXX-XXX *

E-mail Address *

Current Street Address *

Apt. Number

City *

State *

ZIP *

Native Language *

Language spoken in the home *

Parent/Guardian Name(s) (required if applicant is under 18 years old)

Relationship to you

Phone number(s) (required if applicant is under 18 years old)

Parent/Guardian E-mail(s) (required if applicant is under 18 years old)

Your current/last high school attended *

If you have an IEP, please write the name of your RSP teacher

If selected for the Gateway to College Academy (GtC), I agree to abide by the Santa Rosa Junior College (SRJC) Code of Student Conduct, the Petaluma City Schools policies, as well as the policies and procedures of the Gateway to College program.

I also understand that I will be required to attend classes Monday through Friday typically during the times listed below:

Monday-Thursday: 9:00AM-3:00PM; Friday: 9:00AM-2:00PM

If accepted, I understand that all students must attend required classes five days per week, Monday-Friday, including both high school and college courses.

Please print your name if you agree to the terms and conditions written above: *