EmailMe Form - LC1-4 Quarterly Check-In

Name *

First Last

Today's Date *

MM / DD / YYYY

Leadership Class *

LC1

LC2

LC3

LC4

Current School *

Current Grade *

9

10

11

12

Did or will you receive a failing grade (F) on your most recent quarterly or semester report card? *

Yes

No

If yes, in which classes did you receive a failing grade?

Question only for Quarter 4: Were you promoted to the next grade level? *

Yes

No

Have you been suspended (out of school) this semester? *

Yes

No

Have you skipped any classes this semester? *

Yes

No

Current GPA

ACT score

Have you taken 3 years of English? *

Have you taken 2 years foreign language? *

Have you taken any AP classes? *

Have you passed Algebra 2? *

What types of extracurricular activities are you involved in? *

Approximately how many community service hours have you done this semester? *

Include hours completed Summer 2016

Where have you done service? *

Updated Contact Information

Please update any contact information that may have changed.

Updated Address

Street Address City State / Province / Region Postal / Zip Code

Updated Phone

### - ### - ####

Phone Type

Updated Phone

### - ### - ####

Phone Type

Updated Email Address

Other Updates