Student Lottery Information
Please answer the below questions. All questions are required.
Email address *
Student's First Middle Last Name
Your answer
Preferred Name
Your answer
Gender
Grade Applying For
Today's Date
MM
/
DD
/
YYYY
Primary phone to contact for enrollment
Your answer
Does this student have a sibling already enrolled in Learning Bridge?
Address Information
Where does the student reside the majority of the time
Home Address
Street, City, State, Zip
Your answer
Mailing Address
Street, City, State, Zip
Your answer
Parent/Guardian Information - Primary Custody
Complete this section with information about the Parent/Guardian with whom student resides with the majority of the time.
Female's Name
First and Last Name
Your answer
Female's Phone Number
Your answer
Male's Name
First and Last Name
Your answer
Male's Phone Number
Your answer
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