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INDEPENDENCE HIGH SCHOOL APPLICATION FORM
First Name (Primer Nombre)
Middle Name (Segundo Nombre)
Last Name (Apellido)
Village (Aldea)
District (Districto)
Day (Dia)
Month (Mes)
Year (Ano)
Sex (sexo)
Male
Female
Dominant hand (Mano dominante)
Right hand
Left hand
Place of Birth (Lugar de nacimiento):
Nationality (Nacionalidad):
Primary Language (Idioma principal):)
Students Phone:
Ethnicity (Etnicidad):
Religion (Religion):
Does your child have any medical problems (Problemas medicos)?
Yes
No
If yes, please specify:
Primary Contact (Primer contacto)
Name
Primary contact
Father
Mother
Guardian
Village (Aldea)
Occupation (Ocupacion)
Phone
Secondary Contact (Segundo contacto)
Name
Secondary contact
Father
Mother
Guardian
Village (Aldea)
Occupation (Ocupacion)
Phone
For all application to be processed, $20 application fee must be payed to (Heritage Bank # 114-1002).
Picture of birth paper
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Choose Files
Picture of Social Security Card
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Picture of Std. 6 report card
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Picture of receipt ($20 application fee)
*
Drag and Drop (or)
Choose Files
Heritage Bank # 114-1002
Submit application
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