STPS Registration Form
School
Date of Registration
MM
/
DD
/
YYYY
Grade
Last Name of Student
Your answer
First Name of Student
Your answer
Middle Name of Student
Your answer
Nickname
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Race
Ethnicity
Home Language
Your answer
Place of Birth (city/state)
Your answer
Current Age
Your answer
If born outside the US, entry date into the US
MM
/
DD
/
YYYY
Last School Attended Address
Your answer
Home Address
Your answer
Mailing Address (if different than above)
Your answer
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