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JLPAA 2020-2021 Interest Form (B)
PLEASE SUBMIT ONE FORM PER STUDENT. Inquiries received will be added to our interest list in the order they were received. Once they are submitted, we will contact you to give you more information about our program.
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* Indicates required question
Email
*
Your email
Grade in 2020-2021 - Grado en 2020-2021
Transitional Kinder
Kinder
1
2
3
4
5
6
7
Clear selection
Date of Birth - Fecha de Nacimiento
MM
/
DD
/
YYYY
Parent/Guardian First Name - Primer Nombre del Padre/Guardian
*
Your answer
Parent Last Name - Apellido del Padre/Guardian
*
Your answer
Email / Correo electronico
*
Your answer
Physical Street - Nombre de Calle
Your answer
Physical City - Nombre de Ciudad
Your answer
State - Estado
Your answer
Zipcode - Codigo Postal
Your answer
Phone Number / Numero de Telefono
*
Your answer
Student First Name - Primer Nombre del Estudiante
*
Your answer
Student Last Name - Apellido del Estudiante
*
Your answer
Student's Current Grade / Grado Actual del Estudiante
*
TK
K
1
2
3
4
5
6
7
Gender (per Birth Certificate) / Género (por Certificado de Nacimiento)
Female / Femenino
Male / Masculino
Clear selection
How did you hear about Us / Como se entero de nosotros?
*
Facebook / Social Media
Family Member/ Friend / De un miembro de la familia o un amigo
Google Search
Flyer / Folleto
Sign Outside
Number of Students Interested in the 2020-2021 year.- Numero de Estudiantes Interesados
*
Your answer
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