JVHS Student Needs Assessment
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Student Last Name *
Student First Name *
Grade Level *
Current Address *
Current Phone Number *
Personal Email Address *
Emergency Contact Information *
Was the student enrolled in another school during your evacuation? If so, where? *
Will the student be able to attend class virtually beginning  on 10/1 *
If no, when is student anticipated to return?  
MM
/
DD
/
YYYY
Were Uniforms/supplies damages *
Required
If OTHER selected, please explain
Transportation Concerns for testing days
WiFi Concerns, or inability to connect
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