Administration - Senior Information Sheet

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		Senior Information Sheet

Please complete all of the following information. This information will be used by Administration to contact you or your emergency contact in the event we need to reach you outside of school hours. Be sure to verify information before clicking "submit".

Employee's Last Name:

Employee's First Name, Middle Name: (Please use your full legal name)

Room number:

Extension number:

Home Address:

City:

Zip Code:

Home Phone Number:

Cell Phone Number:

Emergency Phone Tree:

Which number would you like us to use for the "emergency phone tree"? Please check one of the options below.

		home
		cell

Spouse's Name:

In case of emergency please contact: (name)

Emergency contact home phone number:

Emergency contact cell phone number:

Emergency contact work phone number:

College(s):

In order to promote a college going culture, we would like to post your college and degree by your classroom.

Degree(s):

Permission to release information:

You have my permission to release my phone number to faculty and staff.

		Yes
		No

Permission to release information in Faculty Directory:

You have my permission to use this information in a LHS Faculty Directory:

		Yes
		No

Date of Birth (Month/Day)

Home E-mail Address (Optional)