*First Name: *Last Name: Middle Initial: *Sex: Select sex M F *Grade Level: Select a grade level 7th Grade 8th Grade Freshman Sophomore Junior Senior

*Address: *City: *State: *Zipcode:

Home Phone: *Email Address:

*Birth Date: Age: Birthplace:

Ethnic Category: White Asian Black Hispanic American Indian Primary Language Spoken at Home:

Primary Guardian's Information

Relation: Father Mother Step-Father Step-Mother Other Family: Family 1 Family 2

First Name: Last Name:

Home Address: City: State: Zipcode:

Home Phone: Work Phone: Email Address:

Secondary Guardian's Information

Relation: Father Mother Step-Father Step-Mother Other Family: Family 1 Family 2

First Name: Last Name:

Home Address: City: State: Zipcode:

Home Phone: Work Phone: Email Address:

Class 1:

Class 2:

Class 3:

Class 4:

Class 5: