First Name *

Middle Initial

Last Name *

Student ID Number *

Please provide your in district address below. IF you will be living in the Snapper Villas that address is 23423 North Co. 22 Canton IL 61520

In District Address:

Street:* *

City *

State *

ZIP *

Email *

Please Type Your Full Name and Date to Sign

Name *

Date *

Help us prevent spam reports.:*

Electronic Signature Agreement. By submitting this form, you are signing this form electronically and confirm that you are the person authorized to sign this form. You further agree that your signature on this document is as valid as if you signed the document in writing, and that no certification or other third party verification of your signature is necessary.