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FACTS INFORMATION
* Indicates required question
Email
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Record my email address with my response
Student First Name
*
Your answer
Student Last Name
*
Your answer
Current Grade
*
Pre-k 3
Pre-k 4
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
Student Birthdate
*
MM
/
DD
/
YYYY
Student Race
*
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other
Hispanic or Latino
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Yes
No
Student Sex
Male
Female
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Religion
*
Catholic
Non-Catholic
Other
Student Address
*
Your answer
City, State
*
Your answer
Zip Code
*
Your answer
Mother's Name (First and Last)
*
Your answer
Mother’s Cell
*
Your answer
Mother's Email
*
Your answer
Father's Name (First and Last)
*
Your answer
Father's Cell
*
Your answer
Father's Email
*
Your answer
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