Non-Primary Application Form

Student Legal Name

First Name

Middle Name

Grade

Pronoun

Date of Birth

Age

Phone Number (parent/guardian)

Current Mailing Address

School Attending

PARENT / GUARDIAN POINT OF CONTACT

Parent

Telephone

E-mail

List of Courses

I hereby affirm that I have read this Application Form and understand how this information will be used. I affirm that the information provided with this Application package, and the testing/assessment results are complete and correct. As indicated by my signature below, I hereby freely and voluntarily consent to have the information provided by me accessible as indicated.

Parent/Guardian Name

Signature of Parent/Guardian

Date