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Student Exploration Survey
Students please fill out this form and show us when you have completed it to win a free gift.
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* Indicates required question
First and Last Name:
*
Your answer
Today's date:
*
MM
/
DD
/
YYYY
Address: (include: # Street, City/Town, State, Zip Code)
*
Your answer
Phone Number:
*
Your answer
Email Address:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Current Grade Level:
*
Grade 7
Grade 8
Grade 9 - Freshman
Grade 10 - Sophomore
Grade 11 - Junior
Grade 12 - Senior
Other:
Gender:
*
Male
Female
Unspecified
High School:
*
SRCS - Salmon River Central School
MCS - Massena Central School
CCVS - Cornwall Collegiate Vocational School
Other:
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