Student Information
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Student Full Name *
Age *
Full address *
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth *
Home Phone
Email address
Emergency Contact Name and Phone Number
Immunizations Up to Date *
Required
Current Grade Level *
Grade Level Applying For *
Has the student ever been suspended from school? *
Required
Has the student ever been expelled from school? *
Required
If yes to either question, please explain.
Does the student have an IEP or 504 Plan? *
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