Shabazz City High School Application for Semester 1, 2019-20
Please fill out the form below to be added to the Shabazz Intake list. By filling out this application form you are giving Shabazz permission to request applicable school records needed for evaluation. You will receive an email explaining the next steps in the application process. We accept new students at the beginning of each semester. You can call our office at 204-2440 with questions or for assistance in filling out the form. NOTE: Please be sure to check your SPAM folder after you submit your application so you don't miss any important correspondence. Thanks!
Student's First Name
Student's Last Name
Student's Date of Birth
Student ID # (if currently at MMSD)
Student's Current Grade
Student's Home Address - Street
Student's Home Address - City
Student's Home Address - State
Student's Home Address - Zip
Student's Current School
East High School
La Follette High School
Memorial High School
West High School
Badger Rock Middle
Spring Harbor Middle
(First and last name of person filling out this form.)
Contact Information - Phone Number
(Please provide the best phone number for us to be in contact with you.)
Contact Information - Email
(Please provide your email address.)
Your relation to the student?
How did you hear about Shabazz?
School staff: counselor, psychologist, other
Word of mouth
Shabazz staff visited school
If you have questions about the application process please call 608-204-2440.
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