Student Information Form

Social Studies 2002-2003

 

Last Name ______________ First Name

 

Date of Birth //

 

Address l
     
City State Zip

 

 

Home Phone ()- ___Email Address (Optional)

 

School I.D. (4 numbers)     ___Official Class

 

___Text Book # (Social Studies)

 

 

Mother/Guardian's Name Mother/Guardian's Work Phone ()-

 

 

Father's Name (or Grandmother/Aunt/Family Friend, etc)

 

Father's (or Grandmother/Aunt/Family Friend,etc) Home Phone ()-

 

Any other number where you can be reached?