GtC Application

If you would like to print and return this form click here.

Please complete and submit this form and we will be in touch with you within 24 hours.

Fields with the red * are required.

First Name *

Last Name *

Phone number *

E-mail Address *

Current Street Address *

Apt. Number

City *

State *

ZIP *

Date of Birth *

Month

Day

Year

Current Age *

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

Native Language *

Language spoken in the home *

Parent/Guardian Name(s)

Relationship to you

Parent/Guardian E-mail(s)

Phone number(s)

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: *