Enrollment Info

Student Enrollment Information

Student Name *

Student Name

First Name

Last Name

Date of Birth *

Date of Birth

MM

DD

YYYY

Parent Name *

Parent Name

This must be the name of the parent that matches the parent name on the scholarship application.

First Name

Last Name

Parent Social Security Number *

This must match the parent named above.

Grade *

Please list the grade the student will be enrolled into once they begin attendance.

General Information

List any relevant general information.