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Dear Student,

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					Dear Student,
Please fill out this top portion of the Niskayuna High School Student Report Form. There is a
sample of the form in its entirety in your red folder. The information you provide will go with your
college applications. RETURN THIS FORM TO YOUR COUNSELOR BY MAY 1.



                                        2010-2011 STUDENT REPORT FORM
                                         NISKAYUNA HIGH SCHOOL
                                        1626 Balltown Road, Niskayuna, NY 12309


STUDENT SECTION -                    Student Number ____________       Counselor ________________

Student Name ____________________________________________________________________
                 Last                        First                                    Middle Initial
Address __________________________________________________________________________
                 Number and Street                   City            State            Zip Code

Birthdate ____/_____/_____ Gender ____               Social Security Number _____________________
                                                                                (Optional)




Dear Student,
Please fill out this top portion of the Niskayuna High School Student Report Form. There is a
sample of the form in its entirety in your red folder. The information you provide will go with your
college applications. RETURN THIS FORM TO YOUR COUNSELOR BY MAY 1.



                                        2010-2011 STUDENT REPORT FORM
                                         NISKAYUNA HIGH SCHOOL
                                        1626 Balltown Road, Niskayuna, NY 12309


STUDENT SECTION -                    Student Number ____________       Counselor ________________

Student Name ____________________________________________________________________
                 Last                        First                                    Middle Initial
Address __________________________________________________________________________
                 Number and Street                   City            State            Zip Code

Birthdate ____/_____/_____ Gender ____               Social Security Number _____________________
                                                                                (Optional)

				
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