Junior DA Program Application

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* 1. First Name

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* 2. Last Name

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* 3. Date of Birth

Date

Date

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* 4. Parent Contact

Parent Name

Address

Parent Email Address

Parent Phone Number

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* 5. School

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* 6. Grade (2023-2024)

8th

9th

10th

11th

12th

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* 7. Interests and Hobbies

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* 8. T-Shirt Size

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* 9. Tell us why you are interested in the Fairbanks Junior DA Program