Information Sheet

Name_______________________________________ Home phone__________________

Grade level_______

Since not everyone lives with both parents, please tell me the

name(s) of the primary caregiver(s) that you live with and his/her relationship to you.

Full Name___________________ Relationship____________ Cell or work phone #___________

Full Name___________________ Relationship____________ Cell or work phone #___________

Do you have a job? No Yes If yes, where? _____________ # of hours a week_____

What is your g.p.a., or what average grade did you earn in most classes? _________

Schedule

Class Name Room Number Teacher Name

1-2

__________________________________________________________________________________

3-4

__________________________________________________________________________________

5-6

__________________________________________________________________________________

7-8

__________________________________________________________________________________

9-10

__________________________________________________________________________________

11-12

__________________________________________________________________________________

13-14

__________________________________________________________________________________

15-16

__________________________________________________________________________________

I have received and read the classroom syllabus rules and procedures

and understand my responsibilities for this class.

___________________________________ ____________________

(signature) (date)