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BlairLEARNs 2021-2022 MS Program Application
$25 non-refundable registration fee* due prior to enrollment. (Check or money order made payable to PUSD. No cash accepted.)
*Registration fee waived for students who qualify for free/reduced lunch.
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Email
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Your email
Student Information
Student Last Name
*
Your answer
Student First Name
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Your answer
Gender
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Male
Female
Non-binary
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Date of Birth
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/
DD
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YYYY
Race/Ethnicity
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Asian
Hispanic or Latino
Black or African American
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Multiracial
Native Hawaiian or Pacific
American Indian or Native American
Other:
Grade in Fall 2021
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K
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Student ID#
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