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Student Information Form
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* Indicates required question
Student Name (FIRST and LAST)
*
Your answer
Name you would like to be called?
*
If you go by a middle name or nickname please let me know.
Your answer
Email Address (school issued preferred).
*
If you do not know your school email address, see my website for directions on how to find it
Your answer
Student phone number (cell or home)
*
I don't plan to call you, but I am asking for this in case there is something important I need to tell you and can't reach you otherwise.
Your answer
Student ID Number
*
Your answer
What type of technology device are you using at home?
*
Your answer
Parent/Guardian Name(s)
*
Your answer
Your Home Address
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Your answer
Parent/Guardian Phone Number(s)
*
List in order of preference and label with names
Your answer
Parent/Guardian Email(s)
*
Please list all email addresses you would like me to use for communication.
Your answer
Is there any important information I need to know right away?
Accessibility issues at home, health concerns
Your answer
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