Student Information

First Name:

Address:
Street:

City:

State: Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Home Telephone:

Email Address:

Grade in 2008-2009 academic year: Select Not Attending Pre-School 3 Pre-K PK 1 2 3 4 5 6 7 8

Child’s Age on December 31, 2008: Select 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Date of Birth:(MM DD YYYY)

Please choose what best describes student’s language skills: Select One Speaks English and Russian equally well Speaks English better but understands and speaks Russian too Speaks Russian better but understands and speaks English Speaks English only Speaks Russian Only

How much time combined has your child spent in Russia or CIS countries from birth till September 1, 2008?

Parents/Guardians Information

Please List any other languages:

Mother/Guardian

First Name:

Do you speak Russian? Select Yes No

If you answered yes please specify : Select Native Acquired

Native Language?

Home phone number:

Work phone number:

Cell phone number:

Email Address:

Father/Other Guardian

First Name:

Do you speak Russian? Select Yes No

If you answered yes please specify : Select Native Acquired

Native Language?

Home phone number:

Work phone number:

Cell phone number:

Email Address: