LongfellowLEARNs 2021-2022 Program Application
$25 non-refundable registration fee* due prior to enrollment. (Check or money order made payable to PUSD. No cash accepted.)
*Registration fee waived for students who qualify for free/reduced lunch.
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Email *
Student Information
Student Last Name *
Student First Name *
Gender *
Date of Birth *
MM
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DD
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YYYY
Race/Ethnicity *
Grade in Fall 2021 *
Student ID#
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