Prospective Student Interest Survey

Thank you for taking the time to complete the on-line interest form. By filling out this interest form, we will contact you about completing an application. The application must then be submitted, with supporting documents, to NMSS.
Survey Results
1	Student Last Name:
	20 Answers Collected
2	Student First Name:
	20 Answers Collected
3	Student Address:
	20 Answers Collected
4	Stu Apt#:
	8 Answers Collected
5	Stu City:
	20 Answers Collected
6	Stu Zip:
	20 Answers Collected
7	Student’s Date of Birth: (mm/dd/yyy)
	20 Answers Collected
8	Student’s gender: (Select one)
	F= Female	50%	(10 Votes)
	M= Male	50%	(10 Votes)
9	Student is applying for grade: (Select one)
	9 = 9th Grade	74%	(14 Votes)
	10= 10th Grade	26%	(5 Votes)
10	Primary language spoken at home:
	20 Answers Collected
11	Before attending this charter school, the student attended: School Name:
	20 Answers Collected
12	School City:
	20 Answers Collected
13	Does the student have records of proper immunizations to attend school? (Records to be collected at time of enrollment)
	Yes	100%	(20 Votes)
	No	0%	(0 Votes)
14	Parent/Guardian 1 Last Name:
	20 Answers Collected
15	Parent 1 First Name:
	20 Answers Collected
16	Parent 1 Home Phone:
	19 Answers Collected
17	Parent 1 Cell Phone:
	19 Answers Collected
18	Parent 1 Email:
	19 Answers Collected
19	Parent 1 Relationship to student:
	20 Answers Collected
20	Parent/Guardian 2 Last Name:
	15 Answers Collected
21	Parent 2 First Name:
	14 Answers Collected
22	Parent 2 Home Phone:
	14 Answers Collected
23	Parent 2 Cell Phone:
	12 Answers Collected
24	Parent 2 Email:
	11 Answers Collected
25	Parent 2 Relationship to student:
	14 Answers Collected
26	Enrolling Student Siblings: (Please provide the First and Last Name, Age and Current School of each sibling) Name Age School
	13 Answers Collected

Survey By: Donna Hackner

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