Username*:

Password*:

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Email Address*:

Student or Faculty?*:

Student or Faculty?*: Student Faculty Both

Salutation: Ms Mrs Mr*:

First Name*:

Maiden Name*:

Married Name:

Address:

Apt:

City:

State:

Zipcode:

Phone:

Saint Michael Academy Graduation Year(s) Input Year if you graduated from either or both. Leave appropriate field blank if you graduated from another grade school or high school. If facultry but non graduate leave blank

High School Grad Year:

Grade School Grad Year: