| Application-ID | SHDHS-026b1- |
|---|---|
| School Year | 2425 |
| Reviewed | No |
| Attending | Yes |
| Primary Parent/ Guardian Information | |
| Primary Parent/ Guardian Name | Amber Chapa |
| Primary Parent / Guardian Email | Email hidden; Javascript is required. |
| Primary Parent / Guardian Phone | (602) 370-1113 |
| Primary Parent / Guardian Address | 1633 Southcross Dr. Hebron, Kentucky 41048 Map It |
| Primary Parent/ Guardian Employer | Cincinnati Children's Hospital |
| Primary Parent/ Guardian Business Phone | (513) 803-6662 |
| Primary Parent/ Guardian Occupation | Admin Assistant |
| Primary Parent/ Guardian Highest Education Level | College Graduate |
| 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? | No |
| Family Religion | Catholic |
| Family Parish Membership | Immaculate Heart of Mary |
| Second Parent/ Guardian Information | |
| Second Parent/ Legal Guardian Name | Allen Chapa |
| Second Parent/ Legal Guardian Email | Email hidden; Javascript is required. |
| Second Parent/ Legal Guardian Primary Phone | (520) 320-9000 |
| Second Parent/ Legal Guardian Address | Kentucky Map It |
| Second Parent/ Legal Guardian Employer | University at Buffalo |
| Second Parent/ Legal Guardian Occupation | Assistant VP for Regional Advancement |
| 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 | Addison Sally Chapa |
| Student 1 Preferred Name | Addison |
| Student 1 - Grade Entering | 9 |
| Student 1 Student Social Security | 764-11-1588 |
| Student 1 Gender | Female |
| Student 1 Birth Date | 10/05/2009 |
| Student 1 Birth Country | United States |
| Student 1 Race | White or Caucasian |
| Student Ethnicity | Hispanic or Latino |
| Student 1 Birth State | Arizona |
| Student 1 Birth County | Maricopa |
| Student 1 County of Residence | Boone County (KY) |
| Student 1 Lives Primary Parent /Guardian (yes/no) | Yes |
| Student 1 School is currently attending or attended | Villa Madonna Academy |
| Athletic Information | |
| Did the student(s) play a sport at your previous school? | Yes |
| Emergency Information | |
| First Emergency Contact Name | Sharon Lane |
| First Emergency Contact Relationship | Grandmother |
| First Emergency Contact Phone | (937) 728-0357 |
| First Emergency Contact Email | Email hidden; Javascript is required. |
