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* 1. What is your contact information?

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* 2. What is your child(ren)'s name, age, gender?

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* 4. Please share any information, concerns, or ideas about your child.

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* 7. Do you have any friends, neighbors, classmates, or church members who might benefit from this program? (whether the Special Needs or Leadership & STEM Academy) If so ... please share their contact information to we can extend a personal invitation!

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* 9. Is there anything else you want to share or discuss with us?

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