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PLEASE CHOOSE FROM THESE PROGRAMS

HIGH SCHOOL PROGRAM

GENERAL INFORMATION

GUARDIAN NAME

RELATION TO THE STUDENT/S

Father

Mother

HOME ADDRESS

STATE

HOME PHONE

CITY

ZIP CODE

CELL PHONE

STUDENT INFORMATION

FIRST NAME

LAST NAME

GENDER

Male

Female

DATE OF BIRTH

COUNTRY OF CITIZENSHIP

PLACE OF BIRTH

RELIGION

PRIMARY LANGUAGE (( STUDENT'S ))

HOME LANGUAGE (( SPOKEN AT HOME ))

PARENTS MARITAL STATUS

Married

Separated

Divorced

STUDENT LIVES WITH

Both Parents

Father

Mother

Other

SCHOOL MOST RECENTLY ATTENDED

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