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* Indicates required question
Student Name
*
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Student phone number
Your answer
Student Email address
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Does student have internet access at home?
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No
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Address
*
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Grade for fall 2020
*
4th
5th
6th
7th
Other:
Parent/Guardian Name
*
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Parent/Guardian Phone
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Any additional students in the household participating?
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Yes
No
Please enter additional students' names & grades
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