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2017 GSMS Application Part 1

Student Information

Grade:

Did You Attend GSMS in 2016?

Preferred Session (current 7th graders only):

First Name: *

Middle Name:

Last Name: *

Nickname:

Date of Birth:(00/00/0000) *
Select a date from the calendar.

Gender:

Race/Ethnicity:
The Governor's Schools of West Virginia have an equal opportunity policy and do not discriminate on the basis of race, color, natural origin, religion, sex or disability.

T-Shirt Size: *

Address Information

Street Address *

Apartment Unit:

City: *

State: *

Postal Code:

County:

Contact Information

(Please enter using the following format: 000-000-0000.)

Home Phone: *

Cell Phone:

Email Address:

School Information

Your School: *

Principal's Name: *

School Phone: *

Family Contact Information

Names of Parents:

Father's Home Phone:

Father's Work Phone:

Father's Cell Phone:

Mother's Home Phone:

Mother's Work Phone:

Mother's Cell Phone:

Date Sent
Select a date from the calendar.

If, after clicking "submit," the page does not change, look back over your application for errors or incomplete blanks. If your application is transmitted successfully, you will receive a brief message thanking you for applying. Print the confirmation page by pressing CTRL-P (Windows) or CMD-P (Apple) and attach it to Part II, the paper part of the application. Students who do not submit both parts of the application by the deadline will be disqualified, add the information that is currently red.

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