VARNUM POTENTIAL STUDENT FORM
AFTER SUBMISSION, ADMINISTRATION WILL REVIEW AND NOTIFY YOU OF NEXT STEP.
Email address *
STUDENT NAME *
PREVIOUS SCHOOL DISTRICT *
STUDENT ENTERING GRADE LEVEL *
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Full Name(s) *
Parent/Guardian Email *
Mailing Address *
Physical Address if different from mailing address (if it is the same type NA OR SAME) *
Home Phone Number or Cell Phone Number *
Does the student have any health or physical conditions that we should be aware of? * *
If you answered "yes" to the above question, please list concerns below.
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