Post by xBlink on Jul 31, 2009 23:55:45 GMT -5
STUDENT INFORMATION
Full Legal Name
(Last/Family/Sur Name, First/Given Name, FULL Middle Name)
Bradford, Shawn Matthew
Preferred Name
(If NOT First/Given Name) [/size]
Just Shawn is fine
Former Last Names
(If Applicable, Otherwise State ‘Not Applicable’) [/size]
N/A
Date of Birth and Time
(mm/dd/yy, hh:mm AM/PM) [/size]
August 5, 1993; 12:15 AM
Gender
(Male/Female) [/size]
Male
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
_X_American
___Pacific Islander
___Other (Specify) ______________
US Social Security Number
(If US Citizen, Otherwise State ‘Not Applicable’) [/size]
11223455678
Address
(Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
N/A; I've never really had a home... I lived on the streets 'till I came here... That is, after the accident.
E-Mail Address
( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
N/A
IM Address
( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
N/A
Desired Email and IM Username
(Username, Password) [/size]
UN:: shawninator
PW:: hotdogs
Home Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
Cell Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
HOUSEHOLD INFORMATION
Who Has Legal Custody?
( Place An ‘X’ Beside Any That Apply)
___Both Parents
___Father
___Mother
___Grandparent(s)
___Guardian(s)
_X_Ward of Court
Student Lives With
(Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
_X_Alone
___Student’s Spouse/Partner
___Other Relative(s)
Parent/Guardian’s Legal Name
(Last/Family/Sur Name, First/Given Name) [/size]
Umm... Bradford, Shawn?
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.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PREVIOUS SCHOOL(S) INFORMATION
Last School Attended
[/size] (Name) [/color] [/size]
(answer here)
Grade
(answer here)
Has your child ever been retained?
(Yes or No If yes, what grade?) [/size]
(answer here)
Has student attended pre-school?
(Yes or No If yes, check one of the following:) [/size]
___ PK-Public School
_X_Private Non-Profit PK
___Public Sponsored PK (Title 1)
___Private For Profit PK
___Head Start
___Other Public School
___PK Private School
List other schools student has attended:
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Has your child ever received any of the following services? [/size]
(If yes, check all that apply) [/size]
_X_Special Education*
_X_Gifted
___Speech*
___ESOL
_X_EIP Reading/Math
___Remedial
___OT/PT*
___504
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
English
Language student uses at home?
Would be English
Language student uses most often?
English once again
Country of Origin?
USA
Date entered US schools:
Augest 16, 1998
[/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)
Bradford, Shawn Matthew
Preferred Name
(If NOT First/Given Name) [/size]
Just Shawn is fine
Former Last Names
(If Applicable, Otherwise State ‘Not Applicable’) [/size]
N/A
Date of Birth and Time
(mm/dd/yy, hh:mm AM/PM) [/size]
August 5, 1993; 12:15 AM
Gender
(Male/Female) [/size]
Male
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
_X_American
___Pacific Islander
___Other (Specify) ______________
US Social Security Number
(If US Citizen, Otherwise State ‘Not Applicable’) [/size]
11223455678
Address
(Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise]) [/size]
N/A; I've never really had a home... I lived on the streets 'till I came here... That is, after the accident.
E-Mail Address
( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com) [/size]
N/A
IM Address
( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site) [/size]
N/A
Desired Email and IM Username
(Username, Password) [/size]
UN:: shawninator
PW:: hotdogs
Home Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
Cell Phone Number
(If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx) [/size]
N/A
HOUSEHOLD INFORMATION
Who Has Legal Custody?
( Place An ‘X’ Beside Any That Apply)
___Both Parents
___Father
___Mother
___Grandparent(s)
___Guardian(s)
_X_Ward of Court
Student Lives With
(Place An ‘X’ Beside Any That Apply) [/size]
___Both Parents
___Father
___Mother
___Step Parent
___Grandparent(s)
___Guardian(s)
___Agency/Social Services
___Foster Parent(s)
_X_Alone
___Student’s Spouse/Partner
___Other Relative(s)
Parent/Guardian’s Legal Name
(Last/Family/Sur Name, First/Given Name) [/size]
Umm... Bradford, Shawn?
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.
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
PREVIOUS SCHOOL(S) INFORMATION
Last School Attended
[/size] (Name) [/color] [/size]
(answer here)
Grade
(answer here)
Has your child ever been retained?
(Yes or No If yes, what grade?) [/size]
(answer here)
Has student attended pre-school?
(Yes or No If yes, check one of the following:) [/size]
___ PK-Public School
_X_Private Non-Profit PK
___Public Sponsored PK (Title 1)
___Private For Profit PK
___Head Start
___Other Public School
___PK Private School
List other schools student has attended:
___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
Has your child ever received any of the following services? [/size]
(If yes, check all that apply) [/size]
_X_Special Education*
_X_Gifted
___Speech*
___ESOL
_X_EIP Reading/Math
___Remedial
___OT/PT*
___504
HOME LANGUAGE SURVEY
Parent or Guardian must complete. [/color]
First Language learned by student?
English
Language student uses at home?
Would be English
Language student uses most often?
English once again
Country of Origin?
USA
Date entered US schools:
Augest 16, 1998
[/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.
All Rights Reserved.