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* 1. Name of School

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* 2. Contact Name

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* 3. Contact Email

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* 4. School/Business Mailing Address

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* 5. School/Business Contact Numbers

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* 6. Date of Visit

Date
Date
Date

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* 7. Number of Students

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* 8. Grade Level

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* 9. Area of Study or Program Focus (e.g. what are you studying in class?)

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* 10. Number of Teachers & Parents 

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* 11. Number of EA's

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* 12. Choose Your Program - Virtual Learning

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* 13. Choose Your Program - Schoolyard Learning

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* 14. Choose Your Program - Park Based Learning

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* 15. Choose Your Preferred Platform (Virtual Learning)

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