Scholar Contact Information Update Form
Please submit this form any time there is a change to a scholar's home address, contact information, or emergency contacts. You do not have to complete fields for information that has not changed.
Scholar's Full Name
*
First Name
Middle Name
Last Name
Suffix
Scholar's Grade Level
*
9th Grade
10th Grade
11th Grade
12th Grade
Scholar's Home Address (Please list primary residence)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this the best address for mailing report cards and other correspondence?
Yes
No
Scholar's Mailing Address (If different from home address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Contact Phone Number
-
Area Code
Phone Number
Primary Contact Phone Type
Home Phone
Cell Phone
Work Phone
Other
Parent/Guardian #1: Name
First Name
Middle Name
Last Name
Suffix
Parent/Guardian #1: Relationship to Scholar
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Sister
Brother
Legal Guardian
Other
If other, please specify
Parent/Guardian #1: Mobile Phone
-
Area Code
Phone Number
Parent/Guardian #1: Home Phone
-
Area Code
Phone Number
Parent/Guardian #1: Work Phone
-
Area Code
Phone Number
Parent/Guardian #1: Email Address
example@example.com
Do you need to list another parent/guardian? (Emergency contacts should be listed in the separate section below.)
Yes
No
Parent/Guardian #2: Name
First Name
Middle Name
Last Name
Suffix
Parent/Guardian #2: Relationship to Scholar
Mother
Father
Grandmother
Grandfather
Aunt
Uncle
Sister
Brother
Legal Guardian
Other
If other, please specify
Parent/Guardian #2: Mobile Phone
-
Area Code
Phone Number
Parent/Guardian #2: Home Phone
-
Area Code
Phone Number
Parent/Guardian #2: Work Phone
-
Area Code
Phone Number
Parent/Guardian #2: Email Address
example@example.com
List the people whom we are permitted to contact and share emergency information about the scholar in the event the parent(s)/guardian(s) are unavailable.
*
List the people who are permitted to pick the scholar up from school. These contacts will not be contacted in the event of an emergency.
*
Submit
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