CENTRAL JERSEY COLLEGE PREP C.S.
Student Database System © 2007-2008
ONLINE STUDENT APPLICATION FORM
 
     
  DEAR PARENTS AND APPLICANT:
  
    Thank you for your interest in Central Jersey College Prep C.S. Please fill out this application form completely. Falsifications, misrepresentations or omissions may disqualify your application.  
   
  Applicant's Personal Information
   
  Year Applying:  
  Grade Applying: *  
  Last Name: *  
  First Name: *  
  Middle Name:  
  Suffix:  
  Date of Birth: *  
  Gender: *  
  Has applicant ever skipped a grade?
* , If Yes Which Grade :
  Has applicant ever repeated a grade?
* , If Yes Which Grade :
  Does the student have any learning disabilities?
*
  if yes, Explain:
 
If Yes, does the applicant currently have Individual Education Plan (IEP)?
*
  Please indicate any special health, or educational needs of which we should be aware of, and which will help us plan and provide for applicant's educational experience:
 
  Please list applicant's honors, awards, or special achievements (in or out of school):
 
  Please list applicant's talents, interests, hobbies, club memberships, and activities:
 
 
Is the applicant currently under expulsion from any school or school district?
*
  if yes, Explain: 
   
  Applicant's School Information  
   
  Current School: *  
  School District:  
  School Address:  
  School Phone:   XXX-XXXXXXX  
  School Fax:   XXX-XXXXXXX  
  Years Attended From:   to  *  
       
  Applicant's Family Information
   
  Applicant lives with: * If Other :
 

 

      
  Primary Parent/Guardian: * If Other : 
  Title :    
  First Name: * Last Name: *
  Address : *
  City: * State: *  Zip:  *
  Home Phone: * Work Phone:
  Cell Phone Email:
         
  Secondary Parent/Guardian: If Other :
  Title    
  First Name: Last Name:
  Address :
  City: State:     Zip: 
  Home Phone: Work Phone:
  Cell Phone Email:
         
  How did you hear about Central Jersey College Prep C.S.?
   
   
     
           
  Please briefly state why you wish to have your child/children enrolled at Central Jersey College Prep C.S..  
   
 
I/We hereby certify that, to the best of my/our knowledge and belief, the answers to the foregoing questions and statements made by me/us in this application are complete and accurate. I/We understand that any false information, omissions, or misrepresentations of facts may result in rejection of this application or future dismissal of the applicant.