Complete High School Maize Student Application

 Name _______________________________________Maiden _________________________________

Address______________________________________ Date of Birth _____________________________

City _____________________Zip _________________SS#___________________________________

Phone ________________________________________Today’s date_____________________________

Last school attended _____________________________Date ___________________________________

Referred by ____________________________________Target graduation date ____________________

Parent/Guardian/Mentor(please designate contact person)

Name #1____________________________________     Name #2______________________________

Relationship _________________________________ Relationship ___________________________

Student’s Employer __________________________________    Phone _____________________

Purpose of employment __________________________________________________

What are your plans after Complete High School Maize?

  

Why do you want to attend Complete High School Maize?

  

What expectations do you have of Complete High School Maize?

  

What do you see as your role as a student at CHSM?

 

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

 

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

 

The above information is true to the best of my knowledge.

Student signature ______________________ Parent signature ________________________

 

 

 

 

Complete High School Maize

Parent/Mentor Application

Student___________________________Relationship____________________________

Parent Name________________________Address_______________________________

Home Phone________________________City/Zip________________________________

Employer___________________________Telephone____________________________

Phone # where you can be reached during the day____________cell phone?_________

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

 

   

What expectations do you have of Complete High School Maize?

  

   

What do you see as your role in this student’s success?

 

 

 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?

         _____________yes                         ________________no

If yes, what ideas do you have for your involvement?

  

Parent signature ______________________________Date___________________

Student signature_____________________________

Return with the student application to:     Deb Elliott, Complete High School Maize

                                                                     120 W. Victory

                                                                     Maize, Kansas 67101

                                                                     Phone: 722-4790

                                                                     Fax: 729-0621