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2021-22 Pathways Student Application
Students need to complete this application before the school will schedule an interview.
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* Indicates required question
Contact Information
Today's Date.
*
MM
/
DD
/
YYYY
Student First and Last Name.
*
Your answer
Student Birth Date. (month, day, year)
*
Your answer
Student Age.
*
Choose
14
15
16
17
18
19
20+
Current Grade Level
*
Choose
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
12th+ Grade
Student Email.
Your answer
Student Cell Phone Number.
*
Your answer
Home Phone Number.
*
Your answer
Parent Name
*
Your answer
Parent Cell Phone Number
*
Your answer
Parent Name (other).
Your answer
Parent Cell Phone Number (other).
Your answer
Physical Address - Street.
*
Your answer
Town
*
Choose
Palmer
Wasilla
Houston
Anchorage
Other
Have you EVER received Special Education Services or had a 504 Plan?
*
Choose
Yes
No
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