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Student information
Please provide information on the student. Parent Information is the next section.
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Student First Name
*
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Student Last Name
*
Your answer
Student Email
*
Your answer
Student Phone number
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
School District
*
Your answer
School Name
*
Your answer
Name of School Counselor
Your answer
Grade
*
9th
10th
11th
12th
Power School Number
Your answer
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