RSBA Returning Student Application Online Form

2022-23 Returning Application Form
Shirt Size:*
Age:*
Date:*

MonthDayYear
Date
Student Information
First Name:*
Middle Name:
Last Name:*
Street Address:*
Apt. #:
City:*
State:*
Zip Code:*
Email Address:
example@example.com
Home Phone:
Cell Phone:
Is this permanent housing?*

YesNo
If no, please briefly describe what type of Temporary Housing the physical address represents:
Birthdate:*

MonthDayYear
Date
Birth City:*
Birth State:*
Birth Country:*
Gender:*

MaleFemaleOther

Emergency Contact
Emergency Contact 1's Name (First & Last):*
Relationship of Emergency Contact 1 to Student (Ex: Aunt, Neighbor, etc.)*
Emergency Contact 1's Cell Number:*
Emergency Contact 1's Other Phone:
Emergency Contact 2's Name (First & Last):*
Relationship of Emergency Contact 2 to Student (Ex: Grandfather, family friend, etc.)*
Cell Number of Emergency Contact 2:*
Other Phone of Emergency Contact 2:

2023-2024 Returning Student Application