The document is a student registration roster for an upcoming school event. It requests the school name, school representative contact information, council district, and a table to list student names, grades, and identification numbers. An office use section notes spaces for the date the form was received and entered.

1. Student Registration Roster
Please print or type name clearly
School Name: _____________________________ School Representative: ______________________
School’s Council District: __________ Contact # for Day of Event: ___________________
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#Student NameGrade #Student
NameGrade 1 2 2 2 3 2 4 2 5 3 6 3 7 3 8 3 9 3 10 35 11 36 12 37 13 38 14 39 15 40 16 41 17 42 18 43 19 44 20 45 21 46 22 47 23 48 24 49 25 50
N 126 227 328 429 530 631 732 833 934 1 3 1 3 1 3 1 3 1 3 1 4 1 4 1 4 1 4 1 4 2 4 2 4 2 4 2 4 2 4 2 5
Office Use Only: Date Received: ___/___/___ Form Entered: ___/___/___

2. School Questionnaire
School Name: ______________________________________________________________________________
School Rep: _______________________________________________________________________________
Are any student organizations represented in your group? If so, which ones?
_________________________________________________________________________________________
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_________________________________________________________________________________________
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_________________________________________________________________________________________
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How were students selected to participate?
_________________________________________________________________________________________
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_________________________________________________________________________________________
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_________________________________________________________________________________________
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Please fax this form to at 210-918-5628
If you have any further questions regarding how to fill out this form
call 210-918-2215 or 210-207-1338
Thank you and we look forward to seeing you there!
Office Use Only: Date Received: ___/___/___ Form Entered: ___/___/___