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Texas Early College High School

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Student Information

School Year Applying For:*

Answer Required

2021-22

2022-23

First Name:*

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Middle Name*

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Last Name*

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Date of Birth:*

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Gender:*

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Male

Female

Street Address

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City

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Zip/Postal

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Student Family Information

First Name:*

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Last Name:*

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Relationship to Student:*

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Father

Mother

Grandparent

Other:

Street Address

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City

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Zip/Postal

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Email Address:*

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Cell Phone:*

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Home Phone:*

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Work Number:*

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CERTIFICATION (Required): By checking this box, I certify to the best of my knowledge and belief that the information in this application is complete and accurate, I am the legal guardian of the child listed above, and I understand that any false information, omission, or misrepresentation of facts may result in the rejection of this application or future dismissal of the applicant.*

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I Agree

Confirmation Email

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