Student Name
First Name
MI
Last Name
Student Email Address (
noname@noname.com
)
Gender
Please select...
Male
Female
Student Phone Number (xxx-xxx-xxxx)
Race
Please select...
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Hispanic or Latino
Brazilian
School
Please select...
Adel DeSoto Minburn High School
Ames High School
Ankeny Centennial High School
Ankeny High School
Brody Middle School
Callanan Middle School
Carlisle High School
Dallas Center-Grimes High School
Des Moines Alternative High School
Des Moines Central Campus
Des Moines Christian High School
Dowling Catholic High School
East High School
Goodrell Middle School
Harding Middle School
Hiatt Middle School
Home School
Hoover High School
Hoyt Middle School
Johnston High School
Lincoln High School
McCombs Middle School
Meredith Middle School
Merrill Middle School
North High School
North Polk High School
Norwalk High School
Other
Roosevelt High School
Saydel High School
Weeks Middle School
Graduation Year
Please select...
2027
2026
2025
2024
2023
2022
2021
If you picked "other" for high school, please enter the name below.
Do you receive free/reduced lunch
Yes
No
Parents Information
First Name
Last Name
Parents Email (
noname@noname.com
)
Parents Phone Number (xxx-xxx-xxxx)
Contact Information