Project W.I.S.E
Women In Science Empowered
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Parents Please fill out each section and email this information back to us for acceptance.
Student Last Name *
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Student First Name *
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Student Middle Initial
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Grade Student Will Be Entering (Fall 2018) *
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Student Date of Birth (MM/DD/YYYY) *
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Student Age as of June 1, 2018 *
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Student Home Street Address/ PO Box Number *
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City *
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State *
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Zip Code *
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Best Phone Number to Contact Parent/Guardian *
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Best Email Address to Contact Parent/Guardian *
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School District *
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Current School *
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Name of Parent/Guardian *
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Day Telephone Number of Parent/Guardian *
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Evening Telephone Number of Parent/Guardian *
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Are you interested in Financial Assistance? *
We Accept Checks and Credit Card payments, Mail Check to 11 Horseshoe Point Ln. North East MD, 21901, for Credit Card Payments call 443.967.0500
(3% convenience fee for credit cards)
A copy of your responses will be emailed to the address you provided.
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