Directions: Complete this survey to the best of your ability

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* 1. Enter Your Full Name  --  EXAMPLE: Lastname, First

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* 2. Students Personal Phone Number?

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* 3. Students E-mail?

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* 4. Mother or Guardian's Complete Name?

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* 5. Mother or Guardian's Phone Number?

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* 6. Mother or Guardian's Home Address?

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* 7. Father or Guardian's Complete Name?

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* 8. Father or Guardian's Phone Number?

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* 9. Father or Guardian's Home Address?

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* 10. Other information that is important for Mr. Peinert to know?

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