* 1. Name of Student (First and Last)

* 2. Student's e-mail address (or parent's email if student does not have one)

* 3. Best Contact Phone Number for Student

* 4. Parent's Name

* 5. Best Contact Phone Number for Parent

* 6. Parent's Email Address

* 7. Choose your age.

* 8. Please write the name of your middle school or high school.

* 9. Do you have a disability?

* 10. Do you have any of the following?

* 11. Do you have a VR counselor?

* 12. What is your primary disability?  If you have more than one, please list the primary followed by the others.

* 13. Do you require any learning accommodations or accessible materials?

* 14. What are your top 3 career choices?

* 15. What do you hope to get out of this week?

* 16. What is your t-shirt size?

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