Student's Name

Student's Science Class Period (Number only 1-6)

Student's ID Number

Student's Home Phone Number

Student's Home Address (Include City, State and Zip Code)

Student's Cell Phone

Student's Email Address

Parent/Guardian #1 Name

Parent/Guardian #1 Home Phone

Parent/Guardian #1 Cell Phone

Parent/Guardian #1 Work Phone

Parent/Guardian #1 Email Address

Parent/Guardian #2 Name

Parent/Guardian #2 Home Phone

Parent/Guardian #2 Cell Phone

Parent/Guardian #2 Work Phone

Parent/Guardian #2 Email Address

Students Birthday

School you attended last year

Who do you live with?

1st period Class

1st period Teacher's Name

2nd period Class

2nd Period Teacher's Name

3rd Period Class

3rd Period Teacher's Name

4th Period Class

4th Period Teacher's Name

5th Period Class

5th period Teacher's Name

6th Period Class

6th Period Teacher's Name

7th Period Class

7th Period Teacher's Name

Tell me something special about yourself!

What sports do you like to play?

Do you have a computer at home?

Does your computer at home have internet?