Credit Acceleration/Credit Recovery Enrollment
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Email *
Student: Last Name *
Student: First Name *
Student: Middle Name
Student: Date of Birth *
Student: Gender *
Student: Current Grade Level *
Federal Race *
Student: Language *
Student: Street Address, City, State, and Zip *
Student: Home Phone *
Student: Cell Phone
Student: Email Address *
School Currently Attending *
District of Residence
Name of Course(s) Needed *
Guardian 1: Last Name *
Guardian 1: First Name *
Guardian 1: Middle Name *
Guardian 1: Primary Phone *
Guardian 1: Cell Phone
Guardian 1: Email Address *
Guardian 1: Street Address *
Guardian 1: City *
Guardian 1: State *
Guardian 1: Zip *
Guardian 1: Relationship *
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