MICHIGAN COLLEGIATE
Re-Enrollment Form
Please Check One Item Below:
Returning
Unsure
Withdrawing
Student's Full Name
Student Date of Birth
-
Month
-
Day
Year
Date
Student's Current Grade
Student's Address
Parent / Guardian Information
Parent/Guardian 1 Name
Relation to Student
Email Address
example@example.com
Phone Number
Address (if different from student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian 2 Full Name
Relation to Student
Email Address
example@example.com
Phone Number
Address (if different from student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contacts
Emergency Contact #1 Name
Relation to Student
Phone Number
Email Address
example@example.com
Address (If different from student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact #2
Relation to Student
Phone Number
Email Address
example@example.com
Address (If different from student)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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