Family Information - Campus Direction

Student Information

Student First and Last Name

First

Last

Nickname

Birthdate

Student's Email

Gender

Pronouns

Citizenship

Dual Citizenship

School Information

School Type

Current School

Currently in Grade

Entering Grade

Expected Date of Entry, New School

Expected Graduation Date, New School

Siblings

Name

Grade

Parent Information

Parents are:

Household

Defined as the primary residence of Student

Parent 1 Name

Defined as the primary contact

Parent 2 Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent 1 Phone

Parent 1 Email

Parent 2 Phone

Parent 2 Email

Email Parent Parent

Parent 2 Address

Optional - Only fill if the address is different from the Household section

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Who will sign the engagement letter and release form, (if appropriate)?

May we send a copy of the forms to the other parent?

To whom should the invoice be sent, if other than Parent 1 or Parent 2?

How did you hear about Campus Direction?

Service Request Date

Select Date

Area of Interest