Student Information Form
Student Information:
First: Last: Address:
City: Zip: email:
Male: Female:
Grade:
9th 10th 11th 12th Period: Student ID:


Guardian Information:  (Male guardian)

First: Last:
Occupation: email:
Home Phone #: Work Phone #:


Guardian Information:  (Female guardian)

First: Last:
Occupation: email:
Home Phone #: Work Phone #:


A few final important questions...

Do you have a computer at home? Yes No
If yes, do you have an Internet connection? Yes No
If you have an Internet connection, is it? Dial-up DSL/Cable modem
Please list any hobbies/interests you have:
What would you like to do for a living?  

Thank you for taking the time to provide this information.