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SWITCH Student Intake Questionaire
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* Required
The first 4 fields require student information only.
This helps us identify who you are and how to contact you.
First Name (student)
*
Your answer
Last Name (student)
*
Your answer
Phone Number (student)
*
Your answer
Email (student)
Your answer
The following 3 fields are for parental/guardian information only.
This helps us know who and where to send consent forms to.
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Parent/Guardian Email
Your answer
The remaining fields are for student information only.
This helps us understand where you are now and where you want to be.
Current Grade Level
*
Choose
9th
10th
11th
12th
Other
Location of School Attending
*
Choose
Houston
Dallas
Austin
San Antonio
Elsewhere in Texas
Outside of Texas
School District
*
Your answer
School Name
Your answer
Please tell us about your favorite hobbies and school subjects. We want you to be excited about what you do!
*
Your answer
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