Contact Information Form

Contact Information Form/ Formulario de Información de Contacto - College Bound

Note: This form is for College Bound students and their parents/guardians to provide their contact information with the program. Providing your cell phone number in this form will also subscribe you to our OtterBot texting program. If you were enrolled in College Bound during middle school, please complete the form so we can keep you updated with resources and important information while you are in high school. We look forward to connecting with you!

Nota: Este formulario es para que los estudiantes College Bound y sus padres/tutores proporcionen su información de contacto con el programa. Proporcionar su número de teléfono celular en este formulario también lo suscribirá a nuestro programa de mensajes de texto OtterBot. Si estuvo inscrito en College Bound durante la secundaria, complete el formulario para que podamos mantenerlo actualizado con recursos e información importante mientras está en la preparatoria. ¡Esperamos conectarnos con usted!

1. Student First Name/ Nombre del Estudiante *This question is required.

2. Student Last Name/ Apellido del Estudiante *This question is required.

3. Student Birthdate/ Fecha de Nacimiento del Estudiante

Ejemplo: Mes/Dia/Año *This question is required. Example: MM/DD/YYYY This question requires a valid date format of MM/DD/YYYY.

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4. Student Email Address/ Correo Electrónico del Estudiante *This question is required. This question requires a valid email address.

5. Student Cell Phone Number/ Numero de Celular del Estudiante Example: XXXXXXXXXX This question requires a valid number format.

6. Parent/Guardian First Name/ Nombre del Padre/Madre/Tutor

7. Parent/Guardian Last Name/ Apellido del Padre/Madre/Tutor

8. Mailing Address/ Dirección *This question is required.

9. City/ Cuidad *This question is required.

10. State/ Estado *This question is required.

11. Zip Code/ Código Postal *This question is required. Example: XXXXX This question requires a valid number format.

12. Parent/Guardian Email Address/ Correo Electrónico de Padre/Madre/Tutor This question requires a valid email address.

13. Parent/Guardian Cell Phone Number/ Número de Teléfono Celular del Padre/Madre/Tutor Example: XXXXXXXXXX This question requires a valid number format.

14. Additional Parent/Guardian First Name/ Nombre Adicional del Padre/Madre/Tutor

15. Additional Parent/Guardian Last Name/ Apellido del Padre/Madre/Tutor Adicional

16. Additional Parent/Guardian Email Address/ Correo Electrónico del Padre/Madre/Tutor Adicional This question requires a valid email address.

17. Would you like to add the contact information for another student?/ ¿Le gustaría agregar la información de contacto de otro estudiante? *This question is required.

Contact Information Form - College Bound

Contact Information Form/ Formulario de Información de Contacto - College Bound