Student Information 2017-2018
STUDENT DEMOGRAPHIC INFORMATION
Student First Name *
Your answer
Student Last Name *
Your answer
Career Technical Program *
Gender *
Required
Birthdate *
MM
/
DD
/
YYYY
Associate School District *
PARENT/GUARDIAN 1
Parent/Guardian *
Parent Guardian Prefix *
Parent/Guardian First Name *
Your answer
Parent/Guardian Middle Initial
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Suffix (Jr., Sr., III)
Your answer
Parent/Guardian Mailing Address *
Your answer
Parent/Guardian Residential Address *
Your answer
Parent/Guardian City *
Your answer
Parent/Guardian State *
Your answer
Parent/Guardian Zip Code *
Your answer
Parent/Guardian County *
Your answer
Parent/Guardian Voice Phone Number *
Your answer
Parent/Guardians Text Phone Number
Your answer
Parent/Guardian Employer
Your answer
Parent/Guardian Work Phone
Your answer
Parent/Guardian E-mail
Your answer
Parent/Guardian Contact Type (Please check all that apply) *
Required
Is there another Parent or Guardian? *
If parents do not live together should correspondence be sent to non-residential parent? *
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