Post by faith on Mar 24, 2010 22:53:58 GMT -5
Completition Informatition
Fill out in accordance to the example below. Once you have completed this form submit it to the Office Inbox. When we accept your applicatition it will be filed and ______ will be added to the Student Roster. No incomplete forms welcome. Thank you and have a nice day.
Form:
STUDENT INFORMATION
Full Legal Name (Last/Family/Sur Name, First/Given Name, FULL Middle Name)
(answer here)
Nightshade Leo
(male) Leo
Preferred Name (If NOT First/Given Name)
(answer here)
Former Last Names (If Applicable, Otherwise State ‘Not Applicable’)
(answer here)
Date of Birth and Time (mm/dd/yy, hh:mm AM/PM)
(answer here)
03 27 1993 8:51 pm
(male)09 10 1988 unknown
Gender (Male/Female)
(answer here)
Female Male
Race (Place An ‘X’ Beside Any That Apply) [/center]
___American Indian
___Alaskan Native
___ Africa
___Asian
___Latin American
___American
___Pacific Islander
__x_Other (Specify) __Canadai_____
(male not to sure think american )
Ethnic Background (Place An ‘X’ Beside Any That Apply)
___American Indian
___Alaskan Native
__x_ Africa
___Asian
__x_Latin American
___American
___Pacific Islander
___Other (Specify) ______________
(male is unknown for everything below)
US Social Security Number (If US Citizen, Otherwise State ‘Not Applicable’)
[Warning: Please DO NOT use yours, or anybody you know’s actually number]
(answer here)
N/A
Address (Number and Street, City; State, Zip Code [If Not Applicable, Please indicate Otherwise])
(answer here)
N/A
E-Mail Address ( If Applicable, Otherwise State ‘Not Applicable’; something@somewhere.com)
(answer here)
N/A
IM Address ( If Applicable, Otherwise State ‘Not Applicable’; list all current; username, site)
(answer here)
N/A
Desired Email and IM Username (Username, Password)
(answer here)
N/A
Home Phone Number (If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx)
(answer here)
N/A
Cell Phone Number (If Applicable, Otherwise State ‘Not Applicable’; (Area Code) xxx-xxx)
(answer here)
N/A
HOUSEHOLD INFORMATION
Who Has Legal Custody? ( Place An ‘X’ Beside Any That Apply)
__x_Both Parents
___Father
___Mother
___Grandparent(s)
___Guardian(s)
___Ward of Court
Student Lives With (Place An ‘X’ Beside Any That Apply)
__x_Both Parents
___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)
(answer here)
Name Of Parent(s)/Sibling(s) Whom Attend/Have Attended Rosethorn Institute (Name, Relationship, Current Grade/Year Attended; [Indicate Graduation Date With An Asterisk (*)]
______________ N/A __________________________
________________________________________
________________________________________
________________________________________
GAURDIAN INFORMATION
Name of Parents/Guardian NOT living in the primary household
(Only list Parents/Guardians that are authorized to have contact with student, but do not live in student’s primary household [Leave Blank If not Applicable])
Legal Name: _________________________ Relationship to student: ______________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)__________ Work Phone: (___)__________ Cell Phone: (___)__________
Legal Name: _________________________ Relationship to student: ______________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)__________ Work Phone: (___)__________ Cell Phone: (___)__________
Legal Name: _________________________ Relationship to student: ______________________
Mailing Address: __________________________________________________________________
Place Of Business: ____________________________________________ Hours: ______________
Place Of Business Address: _________________________________________________________
Home Phone: (___)__________ Work Phone: (___)__________ Cell Phone: (___)__________
PREVIOUS SCHOOL(S) INFORMATION
Last School Attended (Name)
Grade
(answer here)
11
Has your child ever been retained? (Yes or No If yes, what grade?)
(answer here)
no
Has student attended pre-school? (Yes or No If yes, check one of the following:)
___ PK-Public School
___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? (If yes, check all that apply)
___Special Education* ___Gifted ___Speech* ___ESOL
___EIP Reading/Math ___Remedial ___OT/PT* ___504
(answer here)
*If student receives special education including speech or OT/PT, do you have a copy of a current IEP or IAP? (Yes or No)
(answer here)
no
HOME LANGUAGE SURVEY
Parent or Guardian must complete.
First Language learned by student?
(answer here)
Language student uses at home?
(answer here)
Language student uses most often?
(answer here)
Country of Origin?
(answer here)
Canada
Date entered US schools:
(answer here)
LEGAL AGREEMENT
[X] By Checking This Box I Hereby Express My Understanding ThatRosethorn Institute For The Genetically Advanced Accepts FullResponsibility For any harm done to students. I hereby surrende 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.