STUDENT INFO
First Name: *
Middle Name/Initial:
Last Name: *
Student ID Number: *
I.C. e-mail address *
PLEASE UPDATE MY: *	Emer contact Demographic info Both
EMERGENCY CONTACT INFO
PRIMARY CONTACT:
Name (first, initial, last)
Relationship to student	E - Employee Relation F - Father G - Stepfather H - Male Guardian I - Female Guardian L - Legacy Relation M - Mother N - Stepmother O - Other Relation R - Referral S - Sibling Relation X - Guardian
Phone
ALTERNATE EMERGENCY CONTACT:
Name (first, initial, last)
Relationship to student	E - Employee Relation F - Father G - Stepfather H - Male Guardian I - Female Guardian L - Legacy Relation M - Mother N - Stepmother O - Other Relation R - Referral S - Sibling Relation X - Guardian
Phone
SUPPLEMENTAL DEMOGRAPHIC INFO
Religious Preference:	A.M.E. Zion Baptist Breth-Mennonite Buddism Christian Science E. Rite Catholic Episcopal Hindu Islam Judaism Lutheran Orthodox Presbyterian Protestant Quaker Roman Catholic United Church of Christ United Methodist Unitarian other no preference
Marital Status:	Divorced Legally Separated Married Single Widowed