Franklin County School District  
21ST CENTURY COMMUNITY LEARNING CENTERS PROGRAM After-School 2023 - 2024 Enrollment Forms
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Student Name: *
Grade: *
Age: *
Date of Birth: *
MM
/
DD
/
YYYY
Gender: *
Address: with City/State/Zip Code *
Race/ Ethnicity: *
Check any that apply:
Parent Information: Student lives with (check one) *
Number of sisters and brothers (Name and Grade): *
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