Vicksburg Community School
Application for Admission 2008-2009
P.O. Box 821074 ● Vicksburg, MS 39182 ● Tele: (601) 636-7884
Date _____________________________ School Year 2008-2009
STUDENT INFORMATION
Name ________________________________SSN
_________________
First
Middle
Last
School Previously
Attended:___________________________________
Address of School Previously Attended:__________________________
___________________________________________________________
Has student named above ever been suspended or expelled from school?
___ Yes ___ No
Has student listed
above had any dealing with youth courts?
___ Yes ___ No
PARENT INFORMATION
Name:_________________________Home
Phone:______________
Home Address:____________________________________________
City:_______________State:____ Zip:_______________
Father’s
Occupation:____________Work Phone:________________
Employer: ________________________________________________
Employer’s
address:________________________________________
Mother’s
Occupation: _____________Work Phone: _____________
Employer: ________________________________________________________
Employer’s
Address: _______________________________________________________
With whom does the student live? ________ Relationship: ________
Who has legal
custody? _________________________________
List persons whom
are allowed to pick up Child:
________________ Relationship: ____________________
________________
Relationship: ____________________
________________Relationship:
____________________
