CiViL Student Application 2018/2019
2018/2019
First Name *
Your answer
Last Name *
Your answer
Gender *
CiViL Location *
Your answer
Grade *
Your answer
Home Street Address *
Your answer
Home Zip Code *
Your answer
Your Cell Phone
Your answer
Can you receive text messages?
Home Phone
Your answer
Your Email Address
Your answer
Your Birth Date *
Your answer
Name of Parent/Guardian you live with *
Your answer
Parent/Guardian relationship to you *
If other, please explain:
Your answer
Parents'/Guardians' Cell Phone
Your answer
Parents'/Guardians' Work Phone
Your answer
Best time to call parents
Your answer
Parents'/Guardian Email
Your answer
What siblings do you live with?
Your answer
Your school activities
Your answer
Your community activities (church, sports, clubs, etc.)
Your answer
Have you been in CiViL before? *
Names of friends you would like to nominate to join CiViL:
Your answer
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