| A | B | C | D | E | F | G | H | |
|---|---|---|---|---|---|---|---|---|
1 | PERSONAL INFORMATION | |||||||
2 | MY INFORMATION | |||||||
3 | First: | Middle: | Last: | Street Address: | City: | State: | Zip Code: | |
4 | ||||||||
5 | Date of Birth: | Social Security Number: | Email: | Phone Number: | Gender: | |||
6 | ||||||||
7 | US Citizen? | If Non-citizen, Alien Registration #: | ||||||
8 | Yes | |||||||
9 | High School: | CEEB Code: | College Counselor: | Graduation Date: | ||||
10 | Unity Preparatory Charter School of Brooklyn | 330048 | ||||||
11 | PARENT #1 INFORMATION | |||||||
12 | Parent #1: | Living? | Name (first and last): | Date of Birth: | Country of Birth: | Home Address (if different from yours): | ||
13 | ||||||||
14 | Preferred Phone Number: | Education: | Occupation: | Employer: | ||||
15 | ||||||||
16 | PARENT #2 INFORMATION | |||||||
17 | Parent #2: | Living? | Name (first and last): | Date of Birth: | Country of Birth: | Home Address (if different from yours): | ||
18 | ||||||||
19 | Preferred Phone Number: | Education: | Occupation: | Employer: | ||||
20 | ||||||||