CHILD DEVELOPMENT AND CARE DUAL ENROLLMENT PROGRAM INQUIRY
Please submit this form if you are interested in bringing the program to your California-based school or district.
NAME OF HIGH SCHOOL OR SCHOOL DISTRICT
STREET ADDRESS
CITY
ZIP CODE
WEBSITE
FULL NAME
PHONE NUMBER WITH AREA CODE
EMAIL
PROVIDE THREE DATES IN ORDER OF BEST AVAILABILITY FOR AN EXTENSION REPRESENTATIVE TO VISIT YOUR CAMPUS. (PLEASE ALLOW AT LEAST 1-2 WEEK ADVANCE NOTICE)
DESIRED ACADEMIC YEAR IMPLEMENTATION
HOW DID YOU HEAR ABOUT CDC DUAL ENROLLMENT?
ADDITIONAL COMMENTS (OPTIONAL)
Contact Information
