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Cleveland Central Catholic Interest Form
2022-2023 Academic Year
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* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Gender
*
Male
Female
Date of Birth
*
MM
/
DD
/
YYYY
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip
*
Your answer
Current School
*
Your answer
Current Grade
*
Your answer
Does the student currently receive Special Education services?
*
YES
NO
What service plan does the student currently have?
IEP (Individualised Educational Plan)
SP (service Plan)
504 Plan
SEGO
N/A
Parent/Guardian First and Last Name
*
Your answer
Phone number
*
Your answer
Alternate Phone
Your answer
Student Email
*
Your answer
Parent Email
*
Your answer
Are you interested in a tour of Cleveland Central Catholic?
*
Yes
No
Activities of Interest: (Ex: basketball, football, volleyball, clubs)
*
Your answer
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