2019-2020 Student Information
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During what period to you have Mr. Dingman in class this year? *
Last Name *
First Name *
Home Address *
Student Email Address *
With whom do you live? *
If your answer above was "Other", describe who below?
Mom's First Name
Mom's Last Name
Mom's Home Phone Number
Mom's Work Phone Number
Mom's Cell Phone Number
Mom's Email Address
Dad's First Name
Dad's Last Name
Dad's Home Phone Number
Dad's Work Phone Number
Dad's Cell Phone Number
Last Years Math Teacher *
Required
List the extracurricular activities (sports, clubs, MIM, etc) with which you plan to be involved this school year.  If none, write None *
Is there anything that I should know about you that may affect your performance in class this year?   *
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