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Student Information
Please share your information to receive updates from IKIC as well as invitations to various programs and workshops.
Student Name
*
First Name
Middle Name
Last Name
Student Email
*
example@example.com
Student Address
*
Street Address
Apt/Suite/#
City
State
Zip Code
Student Cell
*
Area Code & Phone Number *if no cell enter 000-000-0000
Home Phone
Area code & Phone Number *if no home # enter 000-000-0000
Name of School
*
Africentric
Beechcroft
Briggs
CAHS
Centennial
Central Crossing
Downtown
East
Eastmoor
Franklin Heights
Ft. Hayes
Grove City
Independence
International
Linden-McKinley
Marion Franklin
Mifflin
Northland
South
SW Career Acad
Walnut Ridge
West
Westland
Whetstone
Whitehall
School not listed
Grade Level for Fall 2020
*
6th
7th
8th
9th
10th
11th
12th
Your Student ID Number
*
Enter your student ID number
Student Date of Birth
*
MM/DD/YYYY
Parent or Guardian Name
*
First Name
Last Name
Relationship
*
Mother
Father
Guardian
Grandmother
Grandfather
Aunt
Uncle
Sibling
Other
How is the person above related to you?
Parent or Guardian Email
example@example.com
Parent or Guardian's Cell Phone
*
Area Code & Phone Number *if no cell, enter 000-000-0000
Phone Number
Area Code & Phone Number *if no cell, enter 000-000-0000
Is the parent or guardian's home address the same as yours?
Yes
No
If no, enter your parent or guardian's home address:
Street Address
Apt/Suite/#
City
State
Zip Code
Submit
Should be Empty: