Instituto Justice and Leadership Academy (IJLA)
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Student Information
Información del estudiante
First Name
*
Primer Nombre
This is a required question
Last Name
*
Apellido
This is a required question
What is the student's date of birth?
*
¿Cuál es la fecha de nacimiento del estudiante?
Month
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Year
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How old is the student?
*
¿Cuántos años tiene el estudiante?
This is a required question
Gender
*
Sexo
Male/Masculino
Female/Femenino
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Contact Information
Información de contacto
Student's Cell phone number:
*
Número de celular del estudiante:
This is a required question
Second number of contact:
Segundo teléfono de contacto:
This is a required question
Email address:
Correo electrónico:
Must be a valid email address
This is a required question
What is the address of the student?
*
¿Cuál es la dirección del estudiante?
This is a required question
Zip code
*
Código postal
This is a required question
City, State
*
Ciudad, Estado
This is a required question
Student school information
Información de la escuela del estudiante
Is the student currently out of school?
*
¿Está el estudiante fuera de la escuela actualmente?
Yes/Si
No
This is a required question
IF "NO" What school is she/he enrolled in?
Si "NO" ¿En cuál escuela está actualmente inscrito?
This is a required question
What was the LAST school the student was enrolled in?
*
¿Cuál fue la ULTIMA escuela en la que el estudiante estuvo inscrito?
This is a required question
How did you find out about IJLA?
*
¿Cómo supo de nuestra escuela?
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