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Accelerated Placement Referral Form
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Student's Name
Your answer
Student Address
Your answer
Current Grade
Your answer
Parent's Name
Your answer
Parent's Phone
Your answer
Current School
Your answer
Birthday
MM
/
DD
/
YYYY
Person Referring
Your answer
Role of Person Referring
Parent
Teacher
Other:
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Type of Acceleration Requested
Early entrance to kindergarten
Early entrance to first grade
Single subject acceleration
Grade acceleration
Other:
Clear selection
Why do you feel this child would benefit from acceleration?
Your answer
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