Student: ________________________________________________________________________________

                                Last Name                                            First Name                           Middle Name

 

Home Address:______________________________________________________________________

                                                Number           Street

                          ________________________________________________ Phone No. ( ) _________

                                                City          State                                Zip Code

Name of Parent/Guardian: ________________________________________________________________

 

Name of High School: ___________________________________________________________________

 

Name of Principal: ______________________________________________________________________

 

School Address:________________________________________________ Phone No. ( ) ________

                                     City                          State                       Zip Code

 

________________________________________ ________________________________________

N.J.A.F.P.A. Member Signature                                                        Superintendent’s Signature

 

Write a brief summary and attach to this form. Include the following areas in your summary:

1.             Name(s) of Compensatory Program(s) in which this student participated.

2.             Academic performance based on local standards in grades 9, 10 and 11.

3.             Student attendance based on local standards in grades 9, 10 and 11.

4.             Citizenship in school extra curricular and/or community activities such as church, scouts, 4H, etc.

5.             The type of post high school training the student plans to pursue. Include:

                a. The name and address of the institution the student plans to attend.

                b. The date of admission.

 

 

Name of Funded Program Director/Coordinator: _______________________________________________

 

 

Last Name: _______________________________First Name:___________________________________

 

 

District:_______________________________________________________________________________

 

Address:_______________________________________________________________________________

                                Number                                                 Street

 

______________________________________________________ Phone No. (__ ) _________________

City                                        State                                       Zip Code

 

 

Check the Region of the State your District is located:

 

____North                    ____ Central                                     ____ South