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Request for Additional Information
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Student Information
Student's First Name
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Student's Last Name
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Student's Preferred Name
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Date of Birth
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Gender
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Female
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Current Grade, Fall 2020
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K
1
2
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4
5
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8
Current School
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Home Address
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City
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State
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Zip
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Home Phone
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Parent Contact Information
Mother's Name
Mother's Cell Phone
Mother's Email Address
Father's Name
Father's Cell Phone
Father's Email Address
Parents' Primary Email Address
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Confirm Email Address
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Parents' Primary Cell Phone
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Confirm Parents' Primary Cell Phone
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