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* 1. Name

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* 2. Library Card Number

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* 3. Home Address

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* 4. Email

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* 5. Phone Number

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* 6. Do you belong to any homeschooling groups? If so, please list the group(s) below. 

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* 7. Grade Level Taught (select all that apply)

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* 8. Students ages 5 and above are welcome to attend Homeschool U! How many students do you plan on bringing with you?

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* 9. What are the ages of the students you intend to bring to Homeschool U? (select all that apply)

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* 10. What do you hope to learn from Homeschool U? (50 - 100 words)
Please be as specific as possible. Describe how you plan to use and share the knowledge you gain from Homeschool U and the impact it will have. 

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* 11. How did you discover Homeschool U?

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