Application for DHS Student 2 Student Program

Student Name:______Nickname:______

Home Address:______Home Ph: ______

Gender: ______DOB:______Place of Birth:______Grade:______

# of Years at DHS:______Transferred to DHS?______Military Family? ______

Have you had any discipline referrals while at DHS?______If so, please explain:

______

List current school activities, hobbies, interests:

______

Explain why you would like to serve as a S2S Trainer:

Provide suggestions for activities to help new students adjust:

I understand that after I submit this application, I must participate in a training workshop. If I am selected to serve as a S2S Trainer, I agree to conduct myself with the highest level of integrity. I agree to adhere to all rules set forth by Denbigh High School and Newport News Public Schools. I understand that failure to do so will result in dismissal from the S2S Program.

Student’s Signature:______Date:______

Parent’s Signature:______Date:______

Please submit application no later than Friday, April 1, 2005 to the Guidance Office.