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Solomon Coles Senior Summer Academy Application
Summer of 2018
Name of Student *
Your answer
Social Security #/Student ID *
Your answer
Name of Parent(s)/Guardian(s) *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Physical Home Address *
Your answer
Mailing Address (if different from above)
Your answer
Parent/Guardian Email
Your answer
With whom do you live? *
Your answer
What is their relation to you? *
Your answer
Home/Cell Phone of person you are living with *
Your answer
Name of person who will always be able to reach you. *
Your answer
Home/Cell Phone of Contact Person *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
What is your home campus? *
Your answer
Student's current age *
Your answer
Student's current grade level *
Your answer
Please indicate any medical conditions that require health assistance
Your answer
Is the student under Section 504? *
Is the student in Special Education *
Is the student classified as LEP? *
How will the student get to school?
Is the student a teen parent or are they pregnant?
Note: Transportation and daycare will not be offered.
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