Student General Information
The information collected on this form will only be used for medical and safety purposes. This form will replace the traditional index card so we can collect data from all students whether they are "In Person" learners or "Virtual" learners. The information will be confidential and only be shared with appropriate staff in emergency situations or situations needed for the care and safety of students.
Student's Last Name *
Student's First Name *
Student's Nick Name or Preferred Name
Student Number (Lunch Number)
Student's Gender
Clear selection
Student's Date of Birth *
Student's Cell Number
Student's School Email Address (Need Help? Vist ) *
Student's Personal Email Address
Student's Grade *
Student's 1st Period Teacher (Last Name)
Name of siblings enrolled at Eastside High School
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