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Account Type: Scholar

Parental Information is vital to us as it helps us assess the needs of you as the potential scholar. Please fill out all fields below as best as you can. If you're not sure about certain fields or don't have access to your parental or guardian information you can always save the form and continue later.

Intake Step: Parental / Guardian Information

Primarily lives with:
Both parents	Father	Mother	Grandparent	Other
Parental / Guardian I

Primary Gaurdian Last Name	First Name	Middle Initial
Work Telephone (555-555-5555)	Mobile Telephone (555-555-5555)	Email Address (max 35 char.)
Parental / Guardian II

Primary Gaurdian Last Name

First Name

Middle Initial

Work Telephone (555-555-5555)

Mobile Telephone (555-555-5555)

Email Address (max 35 char.)

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