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Student Information form
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Student Information
Student Name
*
First
Last
Personal Email
*
You have a school email:
[email protected]
Your Cell Phone
*
If you do not have a cell phone, enter your parent’s number here.
Home School Name
*
Biscayne MYcroSchool, Lone Star MYcroSchool, Duval MYcroSchool, Pinellas MYcroSchool, Siatech MYcroSchool, etc.
Student Number
Please enter your student number from your home school if you know it.
Grade Level
*
Choose your grade
9
10
11
12
Gender
*
Male
Female
Please choose gender at birth, we recognize other options but this is for State reporting.
Date of Birth
*
Please double check this to make sure it is correct!
Are you Hispanic or Latino?
*
Yes
No
Layout Name Date
What is your race?
*
White/ non-hispanic
Black/ non-hispanic
Hispanic
Asian/ Pacific Islander
MultiRacial
American Indian/Alaskan Native
Please provide email and phone of someone who can reach you if we cannot get in touch with you:
Email
*
Phone
*
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