Preferred Name

First Name

Last Name

Legal Name *

First Name

Last Name

OSIS#

You will find this nine digit number on your transcript.

(###)

###

####

Date of Birth *

MM

DD

YYYY

Student Phone *

(###)

###

####

Do you know someone who attends Harvey Milk?

Yes

No

Do you have an IEP?

Yes

No

Parent / Guardian Name *

First Name

Last Name

Parent / Guardian Phone *

(###)

###

####