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Student Enrollment Application
Student Information
Student First Name
Student Last Name
Student Gender
Male
Female
Social Security #
Birthday
Birth City
Birth State
Birth Country
Does the student have a current IEP?
Yes
No
Does the student have a current section 504 Plan?
Yes
No
Current Address
Last school attended:
School Name
School Address
School City
School State
School Zipcode
Last Grade Completed
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