360 Reads at Home

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360 Reads at Home

Registration for 360 Reads at Home program access

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* Indicates required question

Your Name *

Your answer

Relationship to student(s) *

Your answer

How soon can the student(s) start? *

This week

Next week

In 2-3 weeks

In the next month

Required

Will you be the person working with the student (facilitator)? *

Yes

No

Sometimes

Facilitator name *

Self

Other:

Required

Facilitator Relationship to Student(s) *

Your answer

Facilitator Phone *

Your answer

Facilitator Email *

Your answer

Facilitator Address *

Your answer

Is there a second facilitator? *

Yes

No

Maybe

Next

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