| Application-ID | SHDHS-c50b0- |
|---|---|
| School Year | 2425 |
| Reviewed | No |
| Attending | Yes |
| Primary Parent/ Guardian Information | |
| Primary Parent/ Guardian Name | Jennifer Blackburn |
| Primary Parent / Guardian Email | Email hidden; Javascript is required. |
| Primary Parent / Guardian Phone | (859) 816-2899 |
| Primary Parent / Guardian Address | 3670 Walnut Park Dr Alexandria, Kentucky 41001 Map It |
| Primary Parent/ Guardian Employer | Bon Secours Mercy health |
| Primary Parent/ Guardian Business Phone | (513) 233-4360 |
| Primary Parent/ Guardian Occupation | Physical therapist |
| Primary Parent/ Guardian Highest Education Level | Graduate Degree or Higher |
| Primary Parent/ Guardian Marital Status | Married |
| Primary Parent/ Guardian Relationship to Student | Parent (Mother) |
| Primary Parent / Guardian Legal Custody (yes/no) | Yes |
| Are you a Saint Henry District High School alumni? | Yes |
| Family Religion | Catholic |
| Family Parish Membership | Other |
| (Other) Family Parish Membership: | St. Mary of the Assumption |
| Second Parent/ Guardian Information | |
| Second Parent/ Legal Guardian Name | William Blackburn |
| Second Parent/ Legal Guardian Email | Email hidden; Javascript is required. |
| Second Parent/ Legal Guardian Primary Phone | (859) 240-3529 |
| Second Parent/ Legal Guardian Address | 3670 Walnut Park Dr Alexandria, Kentucky 41001 Map It |
| Second Parent/ Legal Guardian Employer | St. Elizabeth |
| Second Parent/ Legal Guardian Business Phone | (859) 572-3700 |
| Second Parent/ Legal Guardian Occupation | Physical therapist |
| Second Parent/ Legal Guardian Relationship to Student | Parent (Father) |
| Second Parent/ Legal Guardian Marital Status | Married |
| Second Parent/ Legal Guardian Legal Custody (yes/no) | Yes |
| Second Parent/ Legal Guardian - Lives with Student (yes/no) | Yes |
| Is Second Parent a Saint Henry District High School alumni? | No |
| Student(s) Information Section | |
| Student 1 Legal Name | Molly Ann Blackburn |
| Student 1 Preferred Name | Molly |
| Student 1 - Grade Entering | 9 |
| Student 1 Student Social Security | 406-71-4746 |
| Student 1 Gender | Female |
| Student 1 Birth Date | 12/23/2009 |
| Student 1 Birth Country | United States |
| Student 1 Race | White or Caucasian |
| Student Ethnicity | Non-Hispanic/Latino |
| Student 1 Birth State | Kentucky |
| Student 1 Birth County | Kenton |
| Student 1 County of Residence | Campbell County (KY) |
| Student 1 Lives Primary Parent /Guardian (yes/no) | Yes |
| Student 1 School is currently attending or attended | St. Mary Grade School |
| Athletic Information | |
| Did the student(s) play a sport at your previous school? | Yes |
| Emergency Information | |
| First Emergency Contact Name | Jennifer Blackburn |
| First Emergency Contact Relationship | Mother |
| First Emergency Contact Phone | (859) 816-2899 |
| First Emergency Contact Email | Email hidden; Javascript is required. |
