2020-2021 MPS Returning Student (10th grade)

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Student Information Packet (Registration Information)

Name of Student (Last) *

Name of Student (First) *

Name of Student (Middle) *

Date of Birth *

YYYY

Grade *

10th

Required

Gender *

Male

Female

Required

SSN#

Student's Cell Phone

Street Address (Street, City, State) *

Mailing Address (PO Box or Street, City, Zip) *

Student's Email Address

Give brief directions to your home *

Ethnicity (Check one) *

Hispanic

Non-Hispanic

Required

Racial Groups(s) (Check all that apply): *

Asian

Black

Hawaiian/ Pacific Islander

White

Required

Is this student a twin (or a triplet, quadruplet, etc)? *

Yes

Required

PARENT/ GUARDIAN INFORMATION

Student is living with:

ADULTS LIVING IN HOUSEHOLD RESPONSIBLE FOR THE STUDENT

(IF MORE THAN 2 LIVING IN HOME PLEASE LIST IN COMMENTS AREA.)

(Adult 1) Name (First, Last): (This person gets school messenger alerts.) *

(Adult 1) Relationship to Student *

(Adult 1) Cell Phone Number: *

(Adult 1) Employer *

(Adult 1) Work Phone

(Adult 1) Email Address *

(Adult 2) Name (First, Last):

(Adult 2) Relationship to Student

(Adult 2) Cell Phone Number:

(Adult 2)Employer

(Adult 2) Work Phone

(Adult 2) Email Address

OTHER CHILDREN LIVING IN THE HOME

ONLY COMPLETE IF YOU HAVE OTHER CHILDREN

Name, Birthday, Grade (For Each)

PARENT NOT LIVING IN HOUSEHOLD

ONLY COMPLETE IF ADDITIONAL PARENT(S)

(PARENT NOT LIVING IN HOUSEHOLD) NAME:

PARENT NOT LIVING IN HOUSEHOLD (ADDRESS)

(PARENT NOT LIVING IN HOUSEHOLD) Phone

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