Name: _________________________________ Date: _______________________
Mailing address: _____________________________________ City________________ Zip ____________
Phone: ____________________________ Cell phone: ____________________________
E-mail address (if you have one and check it often): _______________________________________________
MySpace URL: _________________________________________
School: _________________________________________ Grade: _______
Birth date: ______________, 19________ Age: _____ Gender: Female ____
Male ____
(Month, Day) (Year)
What grades do you usually earn? (circle all that apply) A B C D
#1:_______________________________#2:__________________________________
What do you see yourself doing after you graduate from high school? (Check one)
______ Attending a college or university ______ Attending a vocational or technical school ______ Joining the military ______ None of the above. My plans are _____________________
Father/Guardian name: ______________________________ Job: ______________________________
Mother/Guardian name: _____________________________ Job: ______________________________
Is at least one of your parent’s/guardian’s address the same? Y___ N___
If no, their address: __________________________________________
I understand that ETS may need information from my school. I understand that if I want to be eligible for participation in special activities (i.e. field trips), I must attend ETS in-school activities and maintain a grade point average of at least a 2.25 (C average).
_______________________ _________________________________
(Date) (Student Signature)
(rev. 8/07)
