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Student & Family Information

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* Grade level

Student's Full Legal Name

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* First name

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* Last Name

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* Student's Preferred Name (Nickname)

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* Student's Place of Birth - City & State - example: San Francisco, CA

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* Student's Date of Birth (Month/Day/Year) - example: 01/01/1999

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* Student's Social Security Number - example: 000-00-0000

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* Student's Religion

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* Student's Previous School

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* Student's HOME address

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* Student's MAILING address

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* Student Cell Phone - example (415) 000-0000

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* Student's Ethnicity (Please choose ONE)

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