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* 1. Name

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* 2. Name of Parent

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* 4. Parent's or Student's Phone Number

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* 5. Grade Level

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* 6. Name of School

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* 7. Date you will Graduate from High School?

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* 8. Have you applied to a Design School to date?

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* 9. Name of School you have applied to or plan to apply to:

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* 10. Date you would like to attend the Workshop?

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