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Kennebec Valley Community College High School Student Data Collection

All high school students (Early College for ME, Concurrent Enrollment, and Dual Enrollment) will need to fill this out before they can be registered for classes.

 
  

Name Information

*

First Name

 

Middle Name

*

Last Name

 

Suffix

*

Birth Date

*

Gender

 

SSN

 

State Student ID

Race Information

 

Race (Choose one or more)





 

Ethnicity


Contact Information

*

Address Line 1

 

Address Line 2

*

City

*

State

*

Zip Code

*

County

*

Country

*

Primary Phone Number

 

Cell Phone Number

*

Email Address

*

Confirm Email Address

School Information

Enter the name(s) of the high school and vocational / technical center you are currently attending. Click the SAVE button after selecting the institution.

Name of Institution
*

State of Institution

*

Institution

 

Name of Institution

*

Are you an Early College for ME Student?


*

Current Grade Level




*

Do you qualify for Free/Reduced Lunch?


 
  

Candidacy Information

The first question on this page allows the user to choose the year and then dynamically populates the term based on the response to the first question. The second question's data source has a place holder called ##CandidacyYear that is associated with the year question on the Options tab. Defining ## placeholders in data sources requires that another question on the form be associated with that placeholder to be used as an input in the data source at the time it is executed. 

*

What year do you expect to graduate from high school?

*

What year do you plan to enroll in college?

*

What term do you plan to begin your studies?

*

What type of student will you be?

*

Choose a program of study.

Parent/Guardian 1 Information

 

First Name

 

Last Name

*

Is your address different than the student's address?


 

Address

 

City

 

State

 

Zip

*

What was the highest level of education completed by Parent/Guardian 1?

Parent/Guardian 2 Information

 

First Name

 

Last Name

 

Address

 

City

 

State

 

Zip

 

What was the highest level of education completed by Parent/Guardian 2?

Click the Submit button to submit the form.