Post by Kirei on Jun 11, 2010 0:30:11 GMT -5
STUDENT INFORMATION
Full Legal Name
(Last/Family/Sur Name, First/Given Name, FULL Middle Name)
Williams, Selene Nicole
Preferred Name
(If NOT First/Given Name) [/size]
Selene
Former Last Names
(If Applicable, Otherwise State ‘Not Applicable’) [/size]
Not Applicable
Date of Birth and Time
(mm/dd/yy, hh:mm AM/PM) [/size]
11/29/93, 9:56 PM
Gender
(Male/Female) [/size]
Female
Race
(Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___Africa
___Asian
___Latin American
_X_Caucasian
___Pacific Islander
___Other (Specify) ______________
Ethnic Background
(Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
___American
___Pacific Islander
_X_Other (Specify)__Greek/German____
US Social Security Number
(If US Citizen, Otherwise State ‘Not Applicable’) [/size]
12334455678
Address
(Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
1805 N. Chestnut, New York; New York, 10001
E-Mail Address
( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
Selenenicole29@aol.com
IM Address
( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
SeleneNW
Desired Email and IM Username
(Username, Password) [/size]
Selenenicole29, SeleneNW
Home Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
Not Applicable
Cell Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
122 - 349 - 3499
HOUSEHOLD INFORMATION
Who Has Legal Custody?
( Place An ‘X’ Beside Any That Apply)
___Both Parents
_X_Father
___Mother
___Grandparent(s)
___Guardian(s)
___Ward of Court
Student Lives With
(Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
_X_Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
___Alone
___Student’s Spouse/Partner
___Other Relative(s)
Parent/Guardian’s Legal Name
(Last/Family/Sur Name, First/Given Name) [/size]
Williams, Erich
Name Of Parent(s)/Sibling(s) Whom Attend/Have Attended Rosethorn Institute
(Name, Relationship, Current Grade/Year Attended; [Indicate Graduation Date With An Asterisk (*)]
________________________________________ ________________________________________ ________________________________________ ________________________________________
GUARDIAN INFORMATION
Name of Parents/Guardian NOT living in the primary household and current Address.
Sophia Sophronia. 1674 E. Olive Street, New York, 10001__________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
[/size]
Has your child ever received any of the following services? [/size]
(If yes, check all that apply) [/size]
___Special Education*
_X_Gifted
___Speech*
___ESOL
___EIP Reading/Math
___Remedial
___OT/PT*
___504
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
Greek
Language student uses at home?
Greek
Language student uses most often?
English
Country of Origin?
Greece
Date entered US schools:
September 4, 2000
[/size]LEGAL AGREEMENT
[X] By Checking This Box I Hereby Express My Understanding That Rosethorn Institute For The Genetically Advanced Accepts Full Responsibility For any harm done to students. I hereby surrender this child over to the evil clutches of The Headmaster unknowingly and lots other strange fine print I didn’t even read because I assumed this was just another stupid thing. I did not actually read the small part about my student not being allowed to leave the campus unless permission is granted by The Headmaster himself (even though he would never agree to it) even though I said I read it and agree to it.
Full Legal Name
(Last/Family/Sur Name, First/Given Name, FULL Middle Name)
Williams, Selene Nicole
Preferred Name
(If NOT First/Given Name) [/size]
Selene
Former Last Names
(If Applicable, Otherwise State ‘Not Applicable’) [/size]
Not Applicable
Date of Birth and Time
(mm/dd/yy, hh:mm AM/PM) [/size]
11/29/93, 9:56 PM
Gender
(Male/Female) [/size]
Female
Race
(Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___Africa
___Asian
___Latin American
_X_Caucasian
___Pacific Islander
___Other (Specify) ______________
Ethnic Background
(Place An ‘X’ Beside Any That Apply) [/size]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
___American
___Pacific Islander
_X_Other (Specify)__Greek/German____
US Social Security Number
(If US Citizen, Otherwise State ‘Not Applicable’) [/size]
12334455678
Address
(Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
1805 N. Chestnut, New York; New York, 10001
E-Mail Address
( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
Selenenicole29@aol.com
IM Address
( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
SeleneNW
Desired Email and IM Username
(Username, Password) [/size]
Selenenicole29, SeleneNW
Home Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
Not Applicable
Cell Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
122 - 349 - 3499
HOUSEHOLD INFORMATION
Who Has Legal Custody?
( Place An ‘X’ Beside Any That Apply)
___Both Parents
_X_Father
___Mother
___Grandparent(s)
___Guardian(s)
___Ward of Court
Student Lives With
(Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
_X_Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
___Alone
___Student’s Spouse/Partner
___Other Relative(s)
Parent/Guardian’s Legal Name
(Last/Family/Sur Name, First/Given Name) [/size]
Williams, Erich
Name Of Parent(s)/Sibling(s) Whom Attend/Have Attended Rosethorn Institute
(Name, Relationship, Current Grade/Year Attended; [Indicate Graduation Date With An Asterisk (*)]
________________________________________ ________________________________________ ________________________________________ ________________________________________
GUARDIAN INFORMATION
Name of Parents/Guardian NOT living in the primary household and current Address.
Sophia Sophronia. 1674 E. Olive Street, New York, 10001__________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
[/size]
Has your child ever received any of the following services? [/size]
(If yes, check all that apply) [/size]
___Special Education*
_X_Gifted
___Speech*
___ESOL
___EIP Reading/Math
___Remedial
___OT/PT*
___504
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
Greek
Language student uses at home?
Greek
Language student uses most often?
English
Country of Origin?
Greece
Date entered US schools:
September 4, 2000
[/size]LEGAL AGREEMENT
[X] By Checking This Box I Hereby Express My Understanding That Rosethorn Institute For The Genetically Advanced Accepts Full Responsibility For any harm done to students. I hereby surrender this child over to the evil clutches of The Headmaster unknowingly and lots other strange fine print I didn’t even read because I assumed this was just another stupid thing. I did not actually read the small part about my student not being allowed to leave the campus unless permission is granted by The Headmaster himself (even though he would never agree to it) even though I said I read it and agree to it.