Student Application Form
Please provide the following contact information:
Student's Full Name:
Address:
City:
Zipcode:
Phone:
Format ###-###-####
Valid
E-mail Address:
Date of Birth:
Format MM/DD/YY
District High School, if applicable:
Present School:
Counselor:
Special Needs of Student:
Parent/Guardian:
Employer:
Employer's phone:
Parent/Guardian:
Employer:
Employer's phone:
Student ID:
Sex:
Male
Female
Term Preference:
Spring 2007
Fall 2007
Spring 2008
Fall 2008
Spring 2009
Fall 2009
Spring 2010
Fall 2010
Spring 2011
CURRENT GRADE LEVEL:
9th grade
10th grade
11th grade
12th grade
Is English spoken as a SECOND language?:
Yes
No