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2020-2021 CCHS Student Information Sheet
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* Indicates required question
Email
*
Your email
Grade
*
Freshman
Sophomore
Junior
Senior
Student Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Race
*
Black
Caucasion
Hispanic
Asian
Other
Sex
*
Female
Male
County of Residence
*
Your answer
Mailing Address:
*
Your answer
Physical Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Home Phone Number
*
Your answer
A parent or legal guardian's email address
Your answer
Mother's Name
*
Your answer
Mother's Employer
*
Your answer
Mother's phone number
*
Your answer
Mother's phone number
*
Your answer
Mother's Work Number
Your answer
Father's Name
*
Your answer
Father's Employer
Your answer
Father's Phone Number
*
Your answer
Father's Work Number
Your answer
In case of an EMERGENCY and the Parent or Guardian cannot be reached, whom do we call? Please provide 2 other numbers and names besides your own. We must have NAME, RELATION, and PHONE NUMBER of at least two Emergency contacts.
First Emergency Contact Name
*
Your answer
First Emergency Contact Relation
*
Your answer
First Emergency Contact Phone Number
*
Your answer
Second Emergency Contact Name
*
Your answer
Second Emergency Contact Relation
*
Your answer
Second Emergency Contact Number
*
Your answer
Please NOTIFY the school any time you have a change of address or Phone Number.
The Calhoun County School System prohibits discrimination on the basis of race, color, national origin, gender of disability in our educational programs or activities.
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