2020/2021 School Year

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11% of survey complete.

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* 2. Please enter the student's name (first and last) 

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* 4. Please enter the student's age. 

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* 5. What is the student's date of birth?

Date

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* 6. Please enter the student's ID#:

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* 7. Please enter the student's teacher's name:

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* 8. Please select student's gender

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* 9. Please enter the student's home address

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* 10. What is the student's ethnicity?

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* 12. Please enter the name (first and last) of the student's parent/legal guardian:

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* 13. What is the above person's relationship to the student?

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* 14. What is the above person's home address,  email, and cell/home phone number?

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* 15. What is the above person's work phone number?

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* 16. If applicable, please enter the name (first and last) of the student's second parent/legal guardian:

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* 17. What is the above person's relationship to the student?

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* 18. What is the above person's home address, email, and cell/home phone number?

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* 19. What is the above person's work phone number?

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