Student Name and Address

Date of birth

Parent Name and phone

Grade just completed in May 

In the box, please list the class names (not the text) and numeric grades, in a list going down the page, for example: 

Biology  95

Algebra  99

**Please do not skip lines or use all caps  

**Please note "1/2"  if a class is only 1/2 credit - otherwise we will assume 1 full credit has been earned.