2006-2007 Admissions Application
Student Information
Student's Name:
Last First M.I.
Today's Date
//
Grade Level:
Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th
Address:
Street Name/Apt. #
,
City State Zip Code
Ethnicity:
Native American/American Indian African American/Black Caucasian American/White Pacific Islander Other Asian American/Asian
Date of Birth:
Home Phone:
() -
Social Security #:
- -
parent/guardian Information
Mother
Father
Guardian
Name
Cell/Pager
Place of Employment
Work Phone
E-mail Address
Previous school attended
Name of School:
Telephone #:
Principal:
Other Children in Family (Siblings):
Birthdate
Use this space for additional information.
I will notify the school immediately if there are any changes made to my child's information (i.e., address, phone numbers, cell/pager numbers) or medical records.
________________________________________
Signature of Parent
Date
For Office Use Only