* 1. Please respond to the following:

* 2. Montclair High School Student ID#

* 3. What is your Date of Birth?

DOB
/
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* 4. Phone Numbers

* 5. Email Address

* 6. Please indicate your gender:

* 7. Parent/Guardian 1 Information (REQUIRED*)

* 8. Parent/Guardian 2 Information

* 9. What is your ethnicity?

* 10. What language do you mainly speak at home?

 
25% of survey complete.

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