Student Information Form

Social Studies 2002-2003


Last Name ______________ First Name


Date of Birth //


Address l
City State Zip



Home Phone ()- ___Email Address (Optional)


School I.D. (4 numbers)     ___Official Class


___Text Book # (Social Studies)



Mother/Guardian's Name Mother/Guardian's Work Phone ()-



Father's Name (or Grandmother/Aunt/Family Friend, etc)


Father's (or Grandmother/Aunt/Family Friend,etc) Home Phone ()-


Any other number where you can be reached?