Legacy Options HS Student Application Form 2017 - 2018 English
Student Name (Last, First, Middle Initial) *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
DPS Student I.D. *
Your answer
Birth date *
Please type in your birthday month, day, and year in each spot below
MM
/
DD
/
YYYY
Current Grade *
Your answer
Gender
Parents/Guardian Names(s) *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone *
Your answer
Other Phone
Your answer
E-mail *
Your answer
What is your current school name: *
Your answer
What school do you attend: *
Your answer
If you are a high school student how many credit hours do you currently have:
Your answer
If you are a high school student and you don't know your credit hours check box:
What factors in the past have interfered with your success in school (Check all that applies):
Please check all areas in which you feel you need support:
What is your native language:
Your answer
Do you speak more than one language:
Do you have an I.E.P. (Special Education Plan)? *
Do you have a 504 Plan? *
Are you currently expelled? *
If yes from what school:
Your answer
Do you have a Probation Officer? *
If yes what is their name and phone number:
Your answer
Do you have a Human Services case manager or a Safe City Diversion case manager? *
If yes what is their name and phone number:
Your answer
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