Student Information

*Please be advised that this application requires you to upload documentation and will not allow you to go back in to complete the process at a later date/time.

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* 1. Student's legal first name

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* 2. Student's legal last name

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* 3. Student's Birthdate

Date

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* 4. Student's Resident Address

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* 5. Please select the school site you are requesting. (Note: This is a regional program and your preferred school site location may or may not be accommodated).

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* 6. If the preferred location is unavailable, would you still be intersted in attending the Jumpstart program.

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* 7. Student Gender

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* 8. Is this student Hispanic or Latino?

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* 9. What is the race of this student? You may select up to five.

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* 10. Is the student in special education?

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* 11. Is the student on a 504 plan?

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