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 *
Your answer
Student's Last Name *
Your answer
Student's Date of Birth *
MM
/
DD
/
YYYY
Student ID # (if currently at MMSD)
Your answer
Student's Current Grade *
Student's Home Address - Street *
(Street)
Your answer
Student's Home Address - City *
(City)
Your answer
Student's Home Address - State *
(State)
Your answer
Student's Home Address - Zip *
(Zip)
Your answer
Student's Current School *
Your Name *
(First and last name of person filling out this form.)
Your answer
Contact Information - Phone Number *
(Please provide the best phone number for us to be in contact with you.)
Your answer
Contact Information - Email *
(Please provide your email address.)
Your answer
Your relation to the student? *
How did you hear about Shabazz? *
If you have questions about the application process please call 608-204-2440.
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