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* 1. Please enter students full legal name (last, first, mi), address, phone & email contact information.

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* 2. What is your date of Birth?

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* 3. What High School or Middle School do you attend? What class standing will student be in Fall of 2018? (Sr. Jr. Soph. Fresh. 8th, 7th, 6th Grades)

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* 4. What school or after school activities or associations do you participate in if any?

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* 5. Please provide the Parent/Guardian name and contact information below. (Please re-enter just name information if the address is the same as the student information already entered above.)

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* 6. Our Passport Program runs from Sept/Oct to May annually and meets an average 2-3 times monthly, typically on Saturdays from 8:45AM-12:00 Noon with some Elective Classes until 2:30PM and are held at Sage Hill High School at 20402 Newport Coast Drive, Newport Coast, 92657. Can you commit to attending the program on a regular basis? (Parents and Students)

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* 7. Are you a returning Passport Student of prior years? If so, what year and what class standing were you in when you withdrew?

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* 8. Passport to the Future Program and its curriculum emphasizes and requires parent participation that includes intake and exit testing, feedback surveys, meetings, committees and panels, classroom activities, and extra curricular field trip outings as chaperones.
Parent/Guardian can you commit to supporting the Passport Program in these ways?

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* 9. Thank You for your Application Submission! Please provide the name and address of the person who should be contacted regarding acceptance of the student application and notification of Mandatory Student/Parent Orientation meetings?

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* 10. Much of our program information is located on our website at 100bmoc.org. Click on Education. If you have further questions regarding our program please enter them here and we will respond to you. Thank You.

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