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STUDENT INFORMATION

First Name: *

Last Name: *

Email: *

Phone Number: *

PARENT INFORMATION

Lives with: *

Parent 1

First Name: *

Last Name: *

Address: *

Phone: *

Email Address: *

ACADEMIC INFORMATION

School: *

Grade Level Next Fall: *

GPA:

SAT Score (if known):

ACT Score (if known):

COLLEGE ADMISSIONS INFORMATION

Colleges Student Would Like to Apply To (if known):

Desired Major #1 (if known):

Desired Major #2 (if known):

Anything else you'd like us to know:

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What is the best way to reach you?
(Parent phone, parent email, student phone, student email)

How did you hear about us?
(Word of mouth, newsletter, presentation, social media, flyer, other)