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Madison Summer School Interest Survey
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* Indicates required question
Parent Name
*
Your answer
Parent Contact - Email Address
*
Your answer
Parent Contact - Phone #
*
Your answer
Student Name
*
Your answer
Student School
*
Choose
Bernard Long
Madison Student Support Center
Madison Junior High School
Madison Senior High School
Student Grade Level - Please select appropriate grade
*
Choose
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Please Select if you would like to attend Virtual Summer School
*
Choose
Yes, my student would like to attend Virtual Summer School
No, my student would not like to attend Virtual Summer School
Do you currently have internet access at your place of residence?
*
Choose
Yes, I have access to internet where I can use a computer
No, I do not have access to internet where I can use a computer
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