Student Basic Information

Legal First Name:		Legal Last Name:
Preferred Name:		Middle Name:
Gender:		Date of Birth:

Notes:

Student Address

Street:		City:
State:		County:
ZIP:		Race:
Student Email:		Hispanic:
Phone:		Country of Birth:

Academic

		Possible NCAA Athlete?
Grade Level at time of Upcoming Semester:		School:
District:		Local School Name:

Guardians

Guardian 1		Guardian 2
Relationship:		Relationship:
Last Name:		Last Name:
First Name:		First Name:
Email*:		Email:
Phone:		Phone:
*Guardian email must be different from email entered for student.

Student Additional Information



English Language Learner (ELL):		Current IEP:
		Current Section 504: