Student Application - July 12

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Student Application - July 12 - 30, 2021

For Middle and High Schools Students in Hale Co., Greene Co., Sumter Co., Linden City, and West Tuscaloosa. Individual sites located in each area.

Deadline for application submission July 8, 2021.

For additional information email: singletonscholars21@gmail.com

School Name Currently Attending *

Student's Name *

Home Address *

City *

County *

State *

ZIP *

Cell Number

Email *

Parent's / Guardian's Name *

Parent's / Guardian's Phone *

Emergency Contact Name #1 *

Emergency Contact Phone #1 *

Emergency Contact Name #2

Emergency Contact Phone #2

Allergies

Medical Conditions / Concerns

Enter your name below to attest that all of the information I have provided on this application is accurate. I hereby give my permission to have all of the above information verified. *

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