Temecula - Operation School Bell

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Temecula Valley Unified School District Operation School Bell Application

1Date & Time

2Participation Eligibility

3Income Verification

4Student Information

5Family Information

Shopping event location: Kohl's, 24661 Madison Avenue, Murrieta*
- October 6th, Thursday (0 spots)
- October 20th, Thursday (0 spots)
Your student must be present for the Shopping Event and may be registered only one time.
Arrival Time:*
- 4:00pm
- 5:00pm
Your student must be present for the Shopping Event and may be registered only one time.

Participation Eligibility

Before you proceed, you will need to confirm that, based on the income chart below, your Total Family Yearly Income from all sources qualifies you to participate in the shopping event.
Participation Eligibility Confirmation*
By checking the spaces below you are confirming that:
- Based on my Total Family Yearly Income my student(s) are eligible to participate.
- I understand that website registration is the ONLY way my student(s) can register for a shopping event.
  No phone or email registrations will be accepted.
  Register only once per student.

Income Verification
Total Family Yearly Income Confirmation*
- Yes, I understand

Student Information

The following information is required for each student (Transitional K-12) Registered for a shopping event.
Student Last Name*

Enter the Student's information
Student First Name*

Enter the Student's information
Gender*
Enter the Student's information
Date of Birth*
Month
Day
Year

Enter the Student's information
Age*
Please enter a number from 4 to 18.
Enter the Student's information
Grade*
Select Elementary School*
Temecula Valley Unified School District
Select Middle School*
Temecula Valley Unified School District
Select High School*
Temecula Valley Unified School District
Student Street Address*
Street Address City ZIP Code

Enter the Student's information
Ethnicity: (Select ONLY one from the Single-race or Multi-race categories)
Single race category
- White
- Black/African American
- Asian
- American Indian/Alaskan Native
- Native Hawaiian/Other Pacific Islander
Enter the Student's information
Multi-race Category
- American Indian/Alaskan Native & White
- Black/African American & White
- Hispanic/Black/African American
- Hispanic/American Indian/Alaskan Native
- Hispanic/Native Hawaiian/Other Pacific Islander
- Hispanic/American Indian/Alaskan Native & White
- American Indian/Alaskan Native & Black/African American
- Hispanic/American Indian/Alaskan Native & Black/African American
- Other Multi-race (ONLY if, non-of-the-above categories identifies you)
- Asian & White
- Hispanic/White
- Hispanic/Asian
- Hispanic/Asian & White
- Hispanic/Black/African American & White
Enter the Student's information

Family Information
Parent/Guardian Last Name*
Parent/Guardian First Name*
Relationship to Student*
Total Family Size*
Female Head of Household*
- Yes
- No
Parent/Guardian Email Address*
Enter Email Confirm Email
Phone Number*
Do you have another student to register?*
- Yes
- No
Unique ID

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