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Date of Activity *
MM
/
DD
/
YYYY
Start Time of LCE Activity *
MM
/
DD
/
YYYY
Start Time of LCE Class *
Time
:
Activity Location *
Time
:
LCE Class Location *
In-School Teacher Present *
School Class LCE Attends *
Other School Class (if applicable to above)
Students of what grade level(s) participated? *
Topics Covered & Description of Class *
In-School Teacher Comments
Submit
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