Young Marine Record Book
Personal Information
Part I
Enrollment Date: ________________________ Rank: ____________
Last Name: ________________________ First Name: _________________ Middle Initial
_____
Male/ Female: _______ Date of Birth: ______________ Social Security Number:
____________
Young Marine’s Email Address: _________________________ Expected H.S. graduation
date (mm/yyyy) _________
Home Street Address: ___________________________________________
City: ___________________ State: ____________ Zip Code: _________
Living with: _____Mother & Father _____Mother _____ Father _____Legal Guardian
Mother’s Information
Last Name: ______________________ First Name: _______________ Middle Initial
______
Home Street Address: _______________________________________________________
City: ________________________ State: _____________ Zip Code: _____________
Home Phone: (____)_____________________ Work Phone: (____)_______________
Cell Phone: (____)____________________ Email Address:
_____________________________________
Father’s Information
Last Name: _______________________ First Name: _______________ Middle Initial
_______
Home Street Address: _______________________________________________________
City: ______________________ State: ______________ Zip Code: _____________
Home Phone: (____)__________________ Work Phone: (____)____________________
Cell Phone: (____)____________________ Email Address:
_____________________________________
Legal Guardian’s Information
Last Name: _________________________ First Name: ________________ Middle
Initial: _____
Jurisdiction and Court Docket Number: _______________________________________
Home Street Address: _____________________________________________________
City: __________________________ State: _______________ Zip Code: ___________
Home Phone: (____)__________________ Work Phone: (____)___________________
Cell Phone: (____)____________________ Email Address:
_____________________________________
(YMFORM1)