GOODLAND POTENTIAL STUDENT PRELIMINARY ELIGIBILITY QUESTIONNAIRE
POTENTIAL STUDENT PRELIMINARY ELIGIBILITY QUESTIONNAIRE
DATE *
MM
/
DD
/
YYYY
NAME OF LEGAL GUARDIAN.
Your answer
APPLICANT NAME (IF DIFFERENT FROM LEGAL GUARDIAN). *
Your answer
APPLICANT'S RELATION TO POTENTIAL STUDENT.
Your answer
NAME OF POTENTIAL STUDENT
Your answer
YOUR E-MAIL ADDRESS.
Your answer
IF CHILD IS NATIVE AMERICAN, PLEASE PROVIDE NAME OF TRIBE.
Your answer
YOUR PHONE NUMBER(S). *
Your answer
AGE OF POTENTIAL STUDENT (GOODLAND ONLY ACCEPTS STUDENTS AGES 10 - 13). *
Required
ADDRESS.
Your answer
CITY.
Your answer
STATE.
Your answer
ZIP.
Your answer
CHECK ALL THAT APPLY TO CHILD.
ADDITIONAL INFORMATION REGARDING TOPICS IN THE ABOVE BEHAVIOR CHECKLIST.
Your answer
DOES CHILD HAVE ANY OF THE FOLLOWING:
OTHER INFORMATION YOU WOULD LIKE TO PROVIDE.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service