FILE:  JBCB-E

BENTON HARBOR AREA SCHOOLS NON-RESIDENT STUDENT INFORMATION FORM

CHECK AND INITIAL
 
 
School Name
 
 
School Address
 
 
City/State/Zip Code
 
 
(Area Code) School Phone
bullet

Registrar
______
bullet

Attendance Office
______
bullet

Security Office
______
bullet

Nurse
______
bullet

Counselor
______
 
Student Name:  LAST FIRST MIDDLE
     
 
D.O.B. State/Birth Soc. Sec. # Sex Ethnic Code Grade
           
 
Current Address City/State/Zip Phone Number
     
 
Name of Parent(s) /Guardian Relationship
   
 
Name of Emergency Contact Phone Number
   
 
bullet Good Standing
bullet Probation
bullet Academic
bullet Attendance
bullet Disciplinary
bullet Permission to Enroll
 
 
Counselor Signature
 
 
Administrator Signature
   
Check And Initial  
bullet Business Office
_____ Principal's Signature Date
bullet Payment 1st Semester
_____  
bullet Payment 2nd Semester
_____
c:
Assistant Superintendent for Instruction
Assistant Superintendent for Business and Finance
 
 

The Benton Harbor Area Schools, Berrien County, Michigan