FOR THE SCHOOL YEAR BEGINNING IN SEPT. 20_____ FOR GRADE _______________
CHILD'S NAME_____________________________________________________________________
ADDRESS_________________________________________________________________________
PHONE_____________________________ BIRTHDATE_______________GENDER_____________
PRESENT SCHOOL________________________________________________GRADE__________
ADDRESS_________________________________________________________________________
|
*************MOTHER***********************
NAME _________________________________ ADDRESS_____________________________ ______________________________________ HOME_____________WORK______________ E-MAIL _____________________________ PLACE OF EMPLOYMENT_______________ |
**************FATHER*************************
_______________________________________ _______________________________________ _______________________________________ HOME_______________WORK_____________ E-MAIL__________________________________ PLACE OF EMPLOYMENTt_________________ |
I (__)WOULD (__)WOULD NOT NEED FINANCIAL AID.
IS THIS CHILD A SIBLING OF A CHILD CURRENTLY ATTENDING NCCL? ______________
THE CHILD OF A PARENT WHO ATTENDED NCCL? ___________________________________
PARENT SIGNATURE_____________________________ DATE________
_____________________________ DATE________
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OFFICE USE ONLY
APP DATE ________ CK NO __________ AMT ______ VISIT DATE____________
PLACE OFFERED BY _________________ ACCEPTED ON_______________________