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First Name *

Last Name *

CPS ID # *

Gender *

Male

Female

Date of Birth (MM/DD/YYYY) *

Race/Ethnicity *

Asian/Pacific Islander

Black, Non-Hispanic

Hispanic

Native American/Alaskan native

White, Non-Hispanic

Other

Parent/Guardian Name *

Home Address *

Phone *

Parent/Guardian Email *

Student's Current School *

As the applying student I am seeking enrollment for *

9th Grade

10th Grade

11th Grade

12th Grade

Postgraduate

Reason for Requesting Enrollment or Transfer *

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