Student Information Card

First Letter of Last Name

in Box

Name_________________________________________________________________________
ID#__________________________________________________________________________
Period enrolled in Drawing and Painting (circle): 1

Councilors Name_______________________________________________________________
4th Hour Advisory Teachers Name _________________________________________________
Your Best Contact Number________________________________________________________
Your Email Address_____________________________________________________________
Home Address__________________________________________________________________
Language Spoken at Home (circle):

ENGLISH

SPANISH

BOTH

Other:______________

Parent/Guardian Name(s)_________________________________________________________
Parent/Guardian Best Contact Number(s)____________________________________________
Do you have any special needs you would like me to know about? (circle):
LANGUAGE HEARING SEEING FAMILY JOB BABY
Explain_______________________________________________________________________
Health Problems________________________________________________________________
Subject(s) you struggle with_______________________________________________________
Do Not Fill Out Below This Line

Plan For Success Form Returned

Date:

Amount Paid

Date

Amount Paid

Date

Amount Paid

Date

Amount Paid

Date

Semester 1 Lab
Fee

Semester 2 Lab
Fee