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NHS Roster

Contact information for all members. Please answer any questions that pertain to you.


         

       

Name: 


A red asterisk (*) indicates required questions.

  1. What is your mailing address?*


  1. What is your father's name and address? (If you don't want us contacting your father, leave blank.)


  1. What is your mother's name and address? (If you don't want us contacting your mother, leave blank.)


  1. What is your guardian's name and address? (If you don't have a guardian, leave blank.)


  1. What is your e-mail address?


  1. Please retype your e-mail address


  1. What is your family telephone number?


  1. What is your personal cell phone number?


  1. When is your birthday? Please use mm/dd/yyyy format


  1. What is your student ID number used at school?


  1. What are your plans for after graduation?


  1. What extra-curricular activities have you been involved in this year?


  1. What service projects have you been involved in?


  1. Do you earn your own money? If, so, where?


  1. Are there any changes you would recommend for this survey?





Doña Barbara Kissler
Spanish 1-2 & 3-4 and NHS Advisor
North Platte High School
North Platte, NE