Parent/Guardians Info

To be completed by the Parent/Guardian:

This page is to be completed by the parent/guardian. All information given on this page is confidential and is needed for Federal/State reports.

 

Ethnic/Race Data (mark all that apply):

___ American Indian/Alaskan Native  ___ Asian  ___ Hispanic

__African-American/Black ___ Hawaiian/Pacific Islander ___ White (non-Hispanic)

 

Education/Economic Data (Please check as appropriate for each parent/guardian):

Father’s Education:

___ Did not finish high school

___ High School Graduate

___ Community, Technical, or Junior College Graduate

___ Four-year College Graduate

___ Trade or Business School Graduate

___ Graduate School Degree or Beyond


Mother’s Education:

___ Did not finish high school

___ High School Graduate

___ Community, Technical, or Junior College Graduate

___ Four-year College Graduate

___ Trade or Business School Graduate

___ Graduate School Degree or Beyond


Family Income Level (Yearly Income):

___ Less than $15,000            ___ $45,001-$60,000

___ $15,000-$30,000              ___ $60,001-$75,000

___ $30,001-$45,000              ___ Greater than $75,000

___ I choose not to disclose income information.

 

 

 

Parent/Guardian Signature: _________________________________________________ Date: ___________

 

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