2020 Senior Verification Form

Senior Verification Form: Post Completion Contact Information

Student's Program:

JVS Student Number (4XXXXXX):

Student Last Name:

Student First Name:

Student Home Address (Street #, Street, Apt. #):

City:

State:

Zip:

Student Cell Phone:

Student Email Address (NOT @lcjvs.net):

Parent/Guardian Name (First and Last):

Parent/Guardian Phone Number:

Student is presently employed at:

Student's Plans After Graduation:

If attending college, please enter college name:

If attending college - what do you plan to study:

Do you plan to enlist in the Military?

If you are enlisting in the Military - please select branch:

Student's Facebook Name:

Student's Instagram Name:

To validate your submission, please answer the following math problem: