Student Information Form

Please fill out all of the information on this form and submit it.  If there is some information that you cannot or choose not to fill out, please leave it blank.

First Name: Middle Name: Last Name:
 
Address:
City: State: ZipCode:
 
Your Phone: Your Email:
 
Parent's/Guardian's Name: Home Phone: Work Phone:
Parent's/Guardian's Name: Home Phone: Work Phone:
 
Birthdate: Age: Grade:
 
What school did you go to last year?

Current Course:
 
List all science courses you have taken in High School and the teacher of the course

Course:

Teacher:
 
What hobbies/interests do you have?
 
What extracurricular activities are you involved in?
 
What do you expect/want to learn in this class?
 
Do you enjoy science?
 
What are your plans after High School?