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Make your voice heard! We are asking for 100% participation. The survey consist mostly of multiple choice questions and will only take 8-10 minutes to complete. Data collected: Contact info, interests/skills, power of village (POV), community engagement and networks, ideas, and feedback. DUE OCT 14.

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1. Parent/ Guardian Name 1 (Required.)

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2. Parent/ Guardian 1- Primary Phone Number (Required.)

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4. Parent/ Guardian Name 2

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5. Parent/ Guardian 2- Primary Phone Number

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7. Scholar Name 1 (Required.)

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8. Scholar Name 2

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9. Scholar Name 3

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10. Relationship to Imhotep Academy (Select all that apply) (Required.)

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