CONFIDENTIAL Online Registration Form (English)
Please answer all the questions to the best of your ability. If you have questions, please call 507-333-6472 for assistance. All responses with red * are required.
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Where are you completing this form? *
Legal Last Name, First Name, Middle Name *
Full Street Address (include street, apartment #, city, state, and zip code) *
Date of Birth *
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DD
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Primary Phone Number *
What is the best contact method to reach you?
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Gender *
Hispanic
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Race
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Gmail for School/Google Classroom *
Choose Work Status *
Choose Public Assistance Level *
Choose Education Level *
Choose Education Location *
NRS Data (check all  that apply)
Emergency Contact (Name and Phone Number)
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