College & Career Readiness Program Interest Form
Complete this form to be contacted for recruitment by College & Career Readiness Program staff.
Student Name *
Your answer
Grade Level *
High School *
What lunch do you have?
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Birth Date *
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YYYY
Phone Number *
Your answer
Email Address *
Your answer
Home Address *
Your answer
Zip Code *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address
Your answer
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