Parent/Guardian Survey                                            7th Grade Science or STEM
Please take a moment to fill out this brief survey used to collect relevant contact information. Section 2 is optional, but PLEASE hit submit at the end of the survey. I am  the ONLY one that has access to the information that you are providing.

If you are more comfortable sending the information directly via email, feel free. Michelle.paluzzi@wmtps.org 

Please note that MULTIPLE parents or guardians can complete this survey for each student if necessary.
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Student LAST Name *
Student FIRST Name *
Science OR STEM period *
PRIMARY PARENT(S)/GUARDIAN(S)
The following questions apply to the primary parent(s) or guardian(s)
First and last name *
Relationship to student *
Email address *
Phone number(s) - indicate home or cell *
SECONDARY  PARENT(S)/GUARDIAN(S)
The following questions apply to the secondary parent(s) or guardian(s)
First and last name
Relationship to student
Email address
Phone number(s) - indicate home or cell
OTHER INFORMATION
List the adults that the student lives with
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