Physics Information Survey 2018-2019
Last Name *
First Name *
Year in School *
Required
Most Frequently Used Email Address *
Cell Phone Number- Please use this format: (XXX) XXX-XXXX *
Home Phone Number- Please use this format: (XXX) XXX-XXXX *
Are your parents married? *
Required
Parents you are living with: *
Required
Dad's Name (first and last) *
Dad's Cell Phone Number- Please use this format: (XXX) XXX-XXXX *
Dad's email address: *
Mom's First Name (first and last) *
Mom's Cell Phone Number- Please use this format: (XXX) XXX-XXXX *
Mom's email address *
What are two of your favorite songs (that make you smile)? Include artist's name. *
What is one cool thing you did this summer? *
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