| Student's
Name (Last, Middle, First) |
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Social Security Number |
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Current Grade Level: |
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Child's Place of Birth
Child's Date of Birth
Where did you hear about our program?
|
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| (List all addresses
occupied by student)
Address 1:
Address 2:
City, State, Zip Code
|
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| Home Phone Number:
Work Phone Number:
|
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| Last School child Attended |
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| Mother's (Guardian)
Name:
(Last, First) |
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Father's (Guardian)
Name:
(Last, First)
|
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Please summarize why you feel this program is for you.
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|
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I
INTEND TO SUBMIT MY INTEREST FORM FOR ENROLLMENT IN THE SCHOOL OF
INDIVIDUALIZED LEARNING AT DOLORES HUERTA PREPARATORY HIGH. I
understand the form is to show interest in enrollment and that I must
meet with an advisor prior to enrollment to verify qualification for
the program.
|
