| Application-ID | SHDHS-e5b80- |
|---|---|
| School Year | 2425 |
| Reviewed | No |
| Attending | Yes |
| Primary Parent/ Guardian Information | |
| Primary Parent/ Guardian Name | Ben Keipert |
| Primary Parent / Guardian Email | Email hidden; Javascript is required. |
| Primary Parent / Guardian Phone | (859) 743-6544 |
| Primary Parent / Guardian Address | 3133 Boulder Drive Burlington, Kentucky 41005 Map It |
| Primary Parent/ Guardian Employer | Perrigo Inc |
| Primary Parent/ Guardian Occupation | Registered Nurse/Medical Sales |
| 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 | Jason Keipert |
| Second Parent/ Legal Guardian Email | Email hidden; Javascript is required. |
| Second Parent/ Legal Guardian Primary Phone | (859) 393-1843 |
| Second Parent/ Legal Guardian Address | Kentucky Map It |
| Second Parent/ Legal Guardian Employer | Riegler Blacktop |
| Second Parent/ Legal Guardian Occupation | Safety |
| 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? | Yes |
| Student(s) Information Section | |
| Student 1 Legal Name | Benjamin Matthew Keipert |
| Student 1 Preferred Name | Ben |
| Student 1 - Grade Entering | 9 |
| Student 1 Student Social Security | 400-73-4429 |
| Student 1 Gender | Male |
| Student 1 Birth Date | 04/06/2010 |
| 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 | Boone County (KY) |
| Student 1 Lives Primary Parent /Guardian (yes/no) | Yes |
| Student 1 School is currently attending or attended | IHM Grade School |
| Athletic Information | |
| Did the student(s) play a sport at your previous school? | Yes |
| Emergency Information | |
| First Emergency Contact Name | Jamie Keipert |
| First Emergency Contact Relationship | Mother |
| First Emergency Contact Phone | (859) 743-6544 |
| First Emergency Contact Email | Email hidden; Javascript is required. |
