Chiles WLC Ambassador Application

Name:_________________ Grade:_____

Language:______________ Years taken:_____

Parent Signature:______________ Student Signature:________________

Language Teacher Signature:___________________

Comments:
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*If you speak another language at home, you grew up learning English and another
language, or English is not your first language-- Skip the top of this form and fill out
below:

Name:_______________ Grade:______

Language:______________ English (circle): Good Moderate Bad

Parent Signature:___________________

English Teacher Signature:_________________________

Comments:
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