Fillable Form 030714 ADVANTAGE PROGRAM ENROLLMENT FORM ORU

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Form 030714 ADVANTAGE PROGRAM ENROLLMENT FORM ORU

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5247/70714–ADVANTAGEPROGRAMENROLLMENTFORM.DOC|030714

ADVANTAGEPROGRAMENROLLMENTFORM

YearandsemesteryouwishtobegintheAdvantageprogram:20______FallSpring



Name:______________________________________________________PreferredName:___________



Last  First  Middle

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MailingAddress:________________________________________________ _______________________



_____________________________________________________________________________________

CityStateZip

Phone:_______________________________Cell:_________________________________________



Gender:FemaleMaleBirthDate:____/____/____E‐mailAddress:_____________________



CountryofCitizenship:________________________CountryofBirth:__________________________



IfnotaU.S.citizen,checktypeofvisa:Stude nt PermanentResidentVisitorDependent



IsEnglishyourprimarylanguage?YesNoIfno,whatis?_______________________________



Name

ofparent(s)orguardian(s)withwhichyoureside(ifapplicable):___________________________



Nameandmailingaddressofnextofkin:___________________________________________________

Name 

Nextofkinrelationtoyou:_______________________________________________________________



_____________________________________________________________________________________

CityStateZip

NameofHighSchool:___________________________Phone:________________________________

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SchoolAddress:________________________________________________________________________

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_____________________________________________________________________________________

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 CityStateZip

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IaffirmthatORUhaspermissiontodiscussmyacademicprogress withrepresentativesofmyschooland

sendmyORUtranscript(s)tomyschool.



StudentSignature:__________________________ParentSignature:____________________________

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SCHOOL’SAPPROVALTOENROLL:

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CounselorName:___________________________PrincipalName:______________________________

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CounselorSignature:________________________PrincipalSignature:___________________________

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Completed 7 December 2019

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