SHORT Updated Contact Form- Class of 2024

Updated Contact Form

Please take a moment to fill out this survey
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Email (non-school account: gmail, apple, etc.)*
example@example.com
Phone Number*
Please enter a valid phone number.
Please enter your date of birth (month/date/year)*
School*

Banneker High SchoolCreekside High School
Please select your grade level*

nineth gradetenth gradeeleventh gradetwelfth grade
Do you have social media accounts? Please provide your account name.
Instagram blank *
TikTok  Type a label*
Facebook   Type a label*
Twitter   Type a label*
SnapChat   Type a label*
Parent's Name*

First NameLast Name
Parent's Phone Number*
Please enter a valid phone number.
Parent's Email Address*
example@example.com
College Selections (please list all college you are interested in attending)*
College Acceptance (please list all college you have applied to)
SAT/ ACT Please list the dates you have taken the tests and the scores you received (example- "December 2023- 1020")
After high school, plan to:*

College/ Job TrainingWorkMilitary
Do you have any questions for us? Or suggestions for trips or guest speakers?
Please upload a "SELFIE"
Should be Empty: