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2016 Senior Survey & Contact Update
***Please update all information. If you will be moving please give your newest contact information. ALL GRADUATING SENIORS WILL BE CONTACTED AFTER GRADUATION FOR OUR ANNUAL DISTRICT GRADUATION DATA. All information is kept confidential!
* Indicates required question
Moon Valley Student ID#:
*
Your answer
Student's Personal Contact Information
First Name:
*
Your answer
Last Name:
*
Your answer
Student cell phone number:
*
Your answer
Email address (non-Moon Valley email):
*
Your answer
After Graduation. . . . . . .
After Graduation I plan to:
*
Attend a Community College/University/Technical or Trade school
Enter the Military
Work
None of the above
What is the name of the University, Community College, Technical or Trade School?
*Please include the City and State where the school is located*
Your answer
What branch of the Military will you be entering?
Air Force
Army
Coast Guard
Navy
Marines
Clear selection
When will you begin Basic Training? Where?
Your answer
Will you be working part time or full time?
*
Part Time
Full Time
Not Working
Where will you be working?
Please include address or cross streets.
Your answer
Parent/Guardian Contact Information
Home address including city and zip code:
*
Your answer
Home phone number:
*
Your answer
Mother's cell phone number:
*
Your answer
Mother's email:
*
Your answer
Mother's work number:
Your answer
Father's cell phone number:
*
Your answer
Father's email:
*
Your answer
Father's work number:
Your answer
Other Personal Contacts
Please give the name of at least 1 other contact person, other than your parent, someone who will always know where you are.
Contact #1 Name:
*
Your answer
Contact #1-relationship to you
*
Friend
Sibling
Aunt
Uncle
Cousin
Grandparent
Other
Contact #1 Phone number:
*
Your answer
Contact #1 Email address:
*
Your answer
Contact #2 Name:
Your answer
Contact #2-relationship to you
Friend
Sibling
Aunt
Uncle
Cousin
Grandparent
Other
Clear selection
Contact #2 Phone number:
Your answer
Contact #2 Email address:
Your answer
Siblings
Do you have any brothers and/or sisters that will be attending Moon Valley next year?
*
Yes
No
If Yes, what are their first and last names?
Your answer
Do you have any brothers and/or sisters that will be attending another school in the Glendale Union High School District
*
Yes
No
If yes, what are their first and last names?
Your answer
Thank you
Thank you, I appreciate your assistance in completing this form.
I will be talking to you in the Fall!
Mrs. Marshall
Moon Valley High School
Career Center Specialist
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