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STUDENT INFORMATION FORM GRADE_________

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LAST Name FIRST Name Birthday

Computer at home? If so, email address: ___________________________________________________________

What parent do you live with at home? ________________________ List their name & phone number below:

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Parent First Name Parent Last Name Phone # Work #

Parent email address : _________________________________________________________________________

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Parent First Name Parent Last Name Phone # Work #

Parent email address ___________________________________________________________________________

Class Schedule: 1st Hour _______________________ _________________________


2nd Hour _______________________ _________________________
3rd Hour _______________________ _________________________
4th Hour _______________________ _________________________
5th Hour ________________________ _________________________
6th Hour ________________________ _________________________
What Lunch Do You Have? ______

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Math Class Last Year Teacher’s Name Grades Received

List any sports you play, clubs you are in, jobs you have:

Any information you would like me to know to help you succeed in Algebra?
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