Candidate Survey

(Please Print)

Student Name ________________________________

Address ________________________________

________________________________

Home Phone __________________________________________________

E-Mail ___________________________________________________

Academic Lab teacher’s name _______________________________

Current Grade at Pueblo _______________

List any activities you have been involved in during middle school.

____________________________________________________

Have you had any office referrals for poor behavior while at middle school?

No ____ Yes ______ If yes, please explain. _____________________________________________________

_____________________________________________________

Please sign and return by September 4, 2009.

Parent Signature ________________________________ Date _________

Student Signature _______________________ Date _

GPA - 6^th grade _____7^th grade ______(GPA will be determined by NJHS advisors). GPA must be 3.0 overall or higher.