Co-Enrolled Registration Referral Information Please complete the following information Name of person making the referral(required) Phone(required) Email address(required) Relationship to the student being referred(required) Administrator School Counselor Location Atlantic Technical High School Blanche Ely High School Boyd H. Anderson High School Broward Virtual Education High Charles W. Flanagan High School Coconut Creek High School Cooper City High School College Academy @ BCC Coral Glades High School Coral Springs High School Cypress Bay High School Dave Thomas Educational Center Deerfield Beach High School Everglades High School Fort Lauderdale High School Hallandale High School Henry D. Perry Education Center Hollywood Hills High School J. P. Taravella High School McArthur High School McFatter Technical High School Miramar High School Monarch High School Northeast High School Nova High School Piper High School Plantation High School Pompano Beach High School Seagull School Sheridan Technical College Technical High School South Broward High School South Plantation High School Marjory Stoneman Douglas High School Stranahan High School West Broward High School Western High School Whiddon Rogers Education Center Other Student Information Student's First Name(required) Student's Last Name(required) Student Email address(required) Student Telephone Number Student's Identification Number(required) Date of Birth(required) Grade(required) Course Information 1 Select Course 1 Choose from below English Math Science Social Studies English English I English II English III English IV Math Algebra I A Algebra I B Algebra I Geometry Algebra II Liberal Arts Math I Liberal Arts Math II Math for College Readiness Science Biology Chemistry Earth & Space Science Environmental Science Physical Science Social Studies Economics with Final Literacy U.S. History U.S. Government World History Select Semester Needed 1st semester 2nd semester Both semesters Select Course Type Recovery First Impulse Curriculum Type Odysseyware Pen/Paper Reason for Referral Overage for grade Not on track to graduate Poor attendance Select all that apply Course Information 2 Select Course 2 Choose from below English Math Science Social Studies English English I English II English III English IV Math Algebra I A Algebra I B Algebra I Geometry Algebra II Liberal Arts Math I Liberal Arts Math II Math for College Readiness Science Biology Chemistry Earth & Space Science Environmental Science Physical Science Social Studies Economics with Final Literacy U.S. History U.S. Government World History Select Semester Needed 1st semester 2nd semester Both semesters Select Course Type Recovery First Impulse Curriculum Type Odysseyware Pen/Paper Reason for Referral Overage for grade Not on track to graduate Poor attendance Select all that apply Parent Contact Information Parent/Guardian First Name Parent/Guardian Last Name Parent/Guardian's Phone Parent/Guardian's Address 1(required) Parent / Guardian Email address(required) Parent/Guardian's City(required) Parent/Guardian's State(required) Are you human?(required) This field should be left blank Send Please wait...
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