_______________________________
Student's Signature
| Name: | Social Security Number: |
| Home Phone: | email address: |
| Address: | Fr So Jr. Sr Other:________ |
| Advisor: | Major: |
| Team sport: | Former English Class/Instructor's name(s):
Eng. 11 Eng. 12 Other |
| Birthdate: | Food Allergies: chocolate, milk, eggs, other __________ |
Important Information I should know (optional):