DIRECTORY FORM
CHALLENGE EARLY COLLEGE PTO
If you wish to be included in the school directory, please fill out the following form.  One directory will be distributed to each
student.  Please list only the information that you wish to have published in the directory.  PLEASE PRINT CLEARLY!
STUDENT INFORMATION
Student Name_________________________________________ Grade______________
AIM______________________________
E-mail Address__________________________________________________________
Student Phone___________________________  Student Birthday________________
PRIMARY PARENT INFORMATION
Parent(s) Name(s)_________________________________________________________
Home Address____________________________________________________________
City_________________________________  Zip _______________________________
Home Phone________________________ Parent Cell Phone______________________
E-Mail Address___________________________________________________________
SECONDARY PARENT INFORMATION
Parent(s) Name(s)_________________________________________________________
Home Address____________________________________________________________
City_________________________________  Zip _______________________________
Home Phone_____________________________ Parent Cell Phone_________________
E-Mail Address___________________________________________________________
I authorize the Challenge Early College PTO to publish the above information in the School Directory.
________________________________________________ Date_________________
Please print this page and return to school front office by August 30th!
Parent Signature