Student Information

Name

Sex
Male Female

Date of Birth

Name of Current School

Street Address

City

Address (cont.)

State

Zip

  

Parent/Guardian Information

Name

Street Address( if different from above)

City

Address (cont.)

State

Home Phone

  

Zip

  

Work Phone

  

E-mail
Emergency Contact

Name

Telephone

  

  TBEA will not release personal information you provide to third parties without your written consent absent court order or other process.