Student and Parent Application - Complete High School Maize

Required

Please fill out this form if you are interested in attending Complete High School Maize.

1. Namerequired

First Name

Middle (optional)

Last Name

2. Addressrequired

Street, City, State, ZIIP code

3. Email Addressrequired

4. Primary Phonerequired

xxx-xxx-xxxx

5. Date of Birthrequired

mm/dd/yyyy

6. Target Graduation Daterequired

mm/dd/yyyy (Must contain a date in MM/DD/YYYY format)

7. Last School Attendedrequired

8. Date Last School Attendedrequired

mm/dd/yyyy

9. Referred byrequired

10. Contact Name #1 (please designate contact person)required

Parent/Guardian/Mentor/Other

11. Contact phone numberrequired

xxx-xxx-xxxx

12. Relationshiprequired

13. Contact Name #2required

14. Contact phone numberrequired

xxx-xxx-xxxx

15. Relationshiprequired

16. Do you currently live in the Maize School District?required

Yes

17. What are your plans for the future after Complete High School Maize?required

18. Why do you want to attend Complete High School Maize?required

19. What expectations do you have of Complete High School Maize?required

20. What do you see as your role as a student of Complete High School Maize?required

21. What changes do you need to make to be successful in school?required

22. What will be your biggest obstacle to overcome to be a successful student?required

Parent/Guardian/Mentor Application

The following questions are for the Complete High School Maize Parent/Guardian/Mentor

23. Student's Namerequired

First Name

Middle (optional)

Last Name

24. Relationship to Studentrequired

25. Parent Namerequired

First Name

Middle (optional)

Last Name

26. Parent Addressrequired

Street, City, State, ZIP code

27. Parent Email Addressrequired

28. Parent Primary Phonerequired

xxx-xxx-xxxx

29. Employerrequired

30. Employer Phone Numberrequired

xxx-xxx-xxxx

31. Daytime Phone Numberrequired

xxx-xxx-xxxx

32. Why do you want this student to attend Complete High School Maize?required

33. What expectations do you have of Complete High School Maize?required

34. What do you see as your role in this student's success?required

35. Does your child have any allergies? (food, latex, etc.) If yes, please list. required

36. Would you be willing to donate your time to meet with staff, volunteer services, or be directly involved in this student's education in some way?required

Yes

37. If Yes, what ideas do you have for your involvement?

By submitting this application, the student and parent/guardian/mentor state that the above information is true to the best of their knowledge.

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Student and Parent Application - Complete High School Maize