Student name:_________________________________________
WHO
Name of relative student plans to interview: ___________________________
Relationship of relative to student: _________________________________
Approximate age of relative (It’s rude to ask!): ___________
HOW
Check the method(s) of interview student will conduct:
¨ visit in person
¨ phone call
¨ letter
WHEN
Date of interview (when student will call, mail, or visit): ____________________
_______________________________________________ __________
Parent/Guardian Signature Date
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