Student Information

Student Information
Legal Name

First NameMiddle NameLast Name
Preferred Name
Military Dependent

YesNo
Gender
Date of Birth

MonthDayYear
Grade Applying For
Place of Birth

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If born outside US, Date Entered Country

MonthDayYear
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail
Address Information

Where student resides the majority of the time
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address, if different

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Student Address is

On BaseFederal PropertyReservation/ColonyTransitional Living
Should be Empty:

Address Information