DIVISION OF CRIMINAL JUSTICE SERVICES
Student Information Form
REQUESTER DATA:
School Name __________________________________ Telephone # ____________
School Address _______________________________________________________
TITLE OF CALLER _____________________________________
NAME OF DISTRICT SUPERINTENDENT __________________________________
REASON FOR REQUEST:
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SUBJECT DATA:
Full Name __________________________________ Sex ____
Date of Birth ______________ Racial Appearance ____
Height __ Weight ___ Color of Hair ____
Name of Parents/Guardian ______________________________________________
Place of Birth __________________________________________
Social Security Number (if available) ________________________
Other Personal Identification Data:
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September 28, 1987
January 26, 1998