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I need financial assistance purchasing insurance for a school-issued device.
Please complete this form for EACH student needing insurance.
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Email
*
Your email
Student's First and Last Name
*
Your answer
Student's Grade
*
K
1
2
3
4
5
6
7
8
Parent First and Last Name (to be used on insurance policy)
*
Your answer
Parent Phone Number (in case we need to contact you about this)
*
Your answer
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