STUDENT DIRECTORY INFORMATION FORM 2010-2011

DEADLINE FOR SUBMISSION IS JULY 30, 2010

Type in the information in the boxes below as you would like it to appear in the 2010-2011 Dunlap Middle School Student Directory. Only one submission per family is needed. If you have any questions, contact Lara Metzger 243-1976. Entries will be listed alphabetically by the student's last name in the directory. To order a directory, please complete the Directory Order Form which is included in your registration packet from the middle school, and return it to the school with your other registration forms and checks. If you would like to advertise in the directory, please read the information at the bottom of this form.

All fields marked with an * are required in order to proceed.

1. Student Last Name*:

2.First names of all Dunlap Middle School students from the same family with the same last name. (If last names are different, please submit a second form.)

First Name*: Student Grade 2010-2011 6 7 8

First Name: Student Grade 2010-2011 6 7 8

First Name: Student Grade 2010-2011 6 7 8

First Name: Student Grade 2010-2011 6 7 8

3. Parent/Guardian First and Last Names (Select one option and enter it as you want it to appear.)*

*Example: John and Jane Doe

Example: John Doe
       Example: Jane Doe


4. Student Street Address*:
5. City*:
6. Zip*:
7. Primary Phone Number*:
8. Cell or Alternate Phone Number:
9. Primary e-mail Address:

By submitting this form, you verify that the above information is correct
(All entries are subject to school verification).

ADVERTISERS: If you have a business and you would like to advertise in the school directory, please contact Lara Metzger at 243-1976. You can promote your business to nearly 400 families/teachers and support Dunlap Middle School at the same time.