XAVIER UNIVERSITY MONTESSORI LAB SCHOOL
GENERAL STUDENT INFORMATION
ACADEMIC YEAR 2015-2016
Please complete, sign, and return to the school office.
A. Name:
(Child's legal name as listed on birth certificate)
B. Child's gender (circle):
male
female
C. Child's race (circle):
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




Alaskan Native/American Indian
Asian, Pacific Islander
African American, not of Hispanic origin
Hispanic
Caucasian, not of Hispanic origin
Multi-Racial
D. School District (based on child’s residence) ______________________________
Closest local school: _________________________________________________
E. Check one:
PRIVACY REQUESTED: If this box is checked no information pertaining to this student
will be released to any person or institution (including colleges or universities) without your
written approval.
PRIVACY IS NOT REQUESTED
Parent/Guardian's Signature:
Date: ____________________
Rev 4/15: R:\Montessori\LAB SCHOOL\AY 2015-2016\Forms- Required
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