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ENHANCED BASIC EDUCATION ENROLLMENT FORM steal Yer - (heck the appropri box el re eet Er: . wanuawr Diver Me 2 Retning Batwa lex CN InsrRUCTIONS Patni a inkrmation eure CAPITAL kis, Sui accomplished fro the Pra in ChugeReishaytss Ader Use Beck Fen oy LEARNER INFORIATION PSABith Cte Na (ala upon egistaton) nar ate No, LRN) Liste ‘ease me ae of ir MoniaiCyy Festhane = wae | [RP Tes Toe Create Mao Name ‘Belonging t any Indigenous Peoples (P) Communtyndigenous Cultural Community? Dives Dine ives. pease speciy: cent Naw 9H apie) 's your family abenefciary of4ps7 CY Ine ‘Curent addres Tous Walsine co aaa Taisen Framer oat pte Permanent Address Sanewi you CunentAdsnr? ClYex CINe Tous Nolin Seat ina Tease Frommer oan ptaae PARENT SIGUARDIAN'S INFORMATION Ftv tare Frat hare Tid Nae Coo Fo Relig Learner (GallAral and Those Who wil Transfer owe Lint cre Lvl Compt Lt Seo! Year Campiad Lent Sooo! tered sete Prefered Distance Leaming ModaRiies Chosealtt pple Cds Pring Donne ado Basodrstueton CiBlondd Css gta (esuatonal Tein 1 omeschoaing Case to Face ray cety ha te above intomatn given ae ave andcreto he best fay homeo and Tallow te Departnent of Elan fuse ny seal to oat anr opt he kxerriefnfe Lexrerhomaton Sytem The ifomaon her stal be etd as content ncompance wit te Uta Pha Act of ne ‘Spvatuve Over Printed Name of Parent/Guardland Dae

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