Request for Scholar Records
Scholar's First Name: *
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Scholar's Middle Name:
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Scholar's Last Name: *
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Scholar's Grade in 2019-2020: *
Scholar's Homeroom Teacher: *
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Scholar's Date of Birth: *
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DD
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Parent/Guardian's Full Name: *
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Parent/Guardian's Preferred Phone Number: *
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Parent/Guardian's Email Address: *
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Parent/Guardian & Scholar's Address: *
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City: *
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State: *
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Zip Code: *
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What type of school will your scholar be moving to: *
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