CSHS Commemorative Brick Order Form
This is a chance for Seniors, Graduates, Parents, Grandparents, or Friends to buy a brick(s) to honor their graduating Senior. Place your order by December 1, 2017 to be included in this year's engraving.

Each 4" x 8" brick is $100. All monies will be collected by December 1, 2017 in the front office. Checks may be made out to College Station High School.

Email address *
Contact Information
Student Grade *
Your answer
Student First Name: *
Your answer
Student Last Name: *
Your answer
Parent Name: *
Your answer
Parent Email: *
You will receive a copy of this order.
Your answer
Complete your inscription
Line 1 *
Your inscription can have a maximum of 16 CHARACTERS in this line. A character is defined as a letter, number, space or punctuation mark. No special characters.
Your answer
Line 2
Your inscription can have a maximum of 16 CHARACTERS in this line. A character is defined as a letter, number, space or punctuation mark. No special characters.
Your answer
This is an example of how the lines will be laid out on the brick.
If you have any questions, please contact Mr. Southard at 979-694-5800.
Reminder: Your confirmation email must be turned in along with payment to Danielle Valadez at CSHS.
Please note that if CSHS Administration deems a message as inappropriate, CSHS reserves the right to refuse service with full refund.

By submitting this form, you agree to all the terms and conditions established by College Station High School in regards to this fundraiser.

A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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