High School Youth Applicant Information
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Applicant Youth Name *
Youth Date of Birth *
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DD
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Current Age: *
Grade (Spring 2021): *
School (Fall 2021) *
Grade (Fall 2021): *
Student H.O. # (SFUSD Students Only)
With what gender does the applicant identify? *
Race/Ethnicity: *
Does the applicant have an Individualized Education Plan (IEP) or 504 Plan? *
Has the applicant ever been held back a grade? *
Has the applicant ever been expelled from school? *
Has the applicant ever been suspended from school? *
Is the applicant currently receiving any mental health support or services? *
Has the applicant been diagnosed with a cognitive impairment? *
Allergies (Please Specify): *
Seizures: *
Other medical conditions: *
Required medication(s): *
How would you rate the applicant's reading performance? *
How would you rate the applicant's math performance? *
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