* 1. My name is:

* 2. For Fall 2017, I would be interested in taking classes at the following days and locations if they were offered at my level (check all that apply):

* 3. For Fall 2017, I would be interested in taking the following kinds of classes (in addition to my regular class) if they were offered for my age/level (check all that apply):

* 4. For Fall 2017,

* 5. I feel the current length of my level class is:

* 6. Any additional comments or ideas for the Fall 2017 class schedule:

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