East Baton Rouge Parish School Board

P6 AdultPartSur

Adult Partner Registration Form

Directions: After completing the form, click the SUBMIT button to send your application.
You must be at least Twenty-One (21) years old to participate in this program.

*Name

*Gender

*Mailing Address

*City

State

*Zip Code

Work Phone

*Home Phone

Cell Phone

*Email Address

Fax #

Employer

Employer Address

Supervisor

* List Hobbies & Interests

Please list 2 references (other than relatives) who have known you for at least one year and who can vouch for your character, reputation, and ethics. At least one reference should be someone you have known in a professional capacity.

*Reference Name 1

*Relationship 1

Home Phone 1

Work Phone 2

*Reference Name 2

*Relationship 2

Home Phone 2

Work Phone 2

Applicant will be required to undergo a complete state police background check just as an educator would. There is a $10 fingerprinting fee from the State Police that you must pay with a money order. We are seeking corporate sponsorship to defray the additional $50 cost per person for the balance of the check, but you may be asked to pay part or all of that fee.

* Indicates required fields

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EBRPSS, 1050 S. Foster Drive, Baton Rouge, LA 70806, PH 225-922-5400 Contact Us| Jobs | About EBRPSS | Disclaimer | Accessibility | Privacy Statement EBRPSS makes every effort to include educationally appropriate links.

East Baton Rouge Parish School System is an Equal Opportunity Employer


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