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* 1. Your Full Name:

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* 2. Prefers to be Called:

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* 3. Student Email:

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* 4. Cell Phone:

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* 5. Home Phone:

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* 6. Preferred Communication:

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* 7. Birthday

Date

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* 8. Home Language:

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* 9. Mailing Address

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* 10. Ethnicity:

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* 11. How did you hear about us?

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* 12. Siblings (names and ages)

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50% of survey complete.

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