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DesignWorlds for College - High School Parent Information Form

1. Personal & Family Contact Information

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* 1. Your Student's Information

Name (last, first):

School Attending & City:

Grade Level:

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* 2. I am interested in the following program/s:

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* 3. Parent/Guardian Names (Last, First):

Parent/Guardian:

Parent/Guardian:

Other:

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* 4. Will there be more than one parent or guardian involved in this process?

Yes

No

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* 5. Primary contact person is:

Parent 1 or Guardian:

Parent 2 or Guardian

Other (please specify)

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* 6. Address:

Street Address:

City:

State:

Zipcode:

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* 7. Contact Phone Numbers (please provide the best number to contact you at plus a backup number):

Home Phone Number:

Mobile Phone Number (parent/guardian):

Work Phone Number (parent/guardian):

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* 8. Email Addresses:

Primary Email Address:

Secondary Email Address:

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* 9. Other Family Members (name, age & school now attending)

Son(s):

Daughter(s):

Other: