Please Print. Name: High School: Graduation Date:
Please Print. Name: High School: Graduation Date: Social Security Number Xxxxx State ID: Phone Student’s Signature: _ Date: *********************************************************************************** High School Program Teacher: Please initial and indicate by marking an “X” in the box(s) for the course or courses you recommend this student be given credit for or for which you encourage proficiency testing. Students must earn at least a “B” to be given credit. Student is only eligible to earn “up to 12 articulated credits.” Sign and mail to:
Please Print. (* An asterisk indicates that the information is required for processing.)
Please Print. Date Requested Type of Event Event Start time Event End Time Time should include set up and clean up. Address CITY/STATE/ZIP Home phone Business Phone Officer needed Start time: End time:
Please Print. Groom’s/Bride’s Name
Please Print. List the names of all your children currently enrolled in Saugerties Central District Schools and residing at the address listed below. The information given on this form must match the enrollment information you provided during registration.
Please Print. Name: High School: Graduation Date: Social Security Number Xxxxx State ID: Phone Student’s Signature: _ Date: ********************************************************************************** *
Please Print. (* An asterisk indicates that the information is required for processing.) E-mail Address: (Enter an active e-mail address for electronic communication purposes.) Spouse/Partner Name: *Billing Address: _ *City: *State: _ *Zip: _ *Primary Contact Phone: ( _) - Cell Phone: ( _) - Fax Number: ( _) _- *City: _ *State: *Zip: *Emergency Phone Number: ( ) - Employer Name: Work Phone: ( ) - MDU Account Holder Name Signature Name that will appear on the xxxx-financially responsible person or entity Date: _ CSA ID# Processed by: Date: Continuous Service Agreement Form – Rev. 09-24-2015 - Email: xxxxxxxxxxxxxxx@xxx.xxx - Fax: 000-000-0000 or 0.
Please Print. (* An asterisk indicates that the information is required for processing.) E-mail Address: (Enter an active e-mail address for electronic communication purposes.) Spouse/Partner Name: *City: *State: _ *Zip: *Primary Contact Phone: ( ) - Cell Phone: ( ) - Fax Number: ( ) - *City: _ *State: _ *Zip: *Emergency Phone Number: ( ) - Employer Name: Work Phone: ( ) - MDU Account Holder Name Signature Name that will appear on the xxxx-financially responsible person or entity Date: CSA ID# Processed by: Date: Continuous Service Agreement Form – Rev. 01/01/2019 - Email: xxxxxxxxxxxxxxx@xxx.xxx - Fax: 000-000-0000 or 0.
