SECTION I-To be completed by the applicant's parent (s) or guardian (s)

Applicant's Name
	First	Middle	Last
Preferred Name
Gender:       M       F
Date of Birth:	Age:
Student's social security number:
Parent(s) social security number:
Applying for Grade:
With whom does applicant reside?
	Name		Relationship
Phone:
Address:
	Street	Apt. No.	City              Zip
Father's Name:
Occupation:		Name of Business:
Business Address:
Home Phone:		Business Phone:
Mother's Name:
Occupation:		Name of Business:
Business Address:
Home Phone:		Business Phone:

If the applicant does not live with both parents, please check the appropriate statement(s).

Parents are:        Separated	Father:        Remarried	Mother:        Remarried
Divorced	Deceased	Deceased
Other:

Other Children in the Family:

Name	Age	Present School

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