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SCOPE Prep Program Application

 

 

 Student Name   

 Address

    

 City

   

 Home Phone

   

 Date of Birth

   

 Gender

  
   
  

School Information 

Name of School

  

Name of Principal

  

Name of Teacher

   

Grade:

   

Student is eiligible for free
and reduced hot lunch program?

    

Parent Information

 

Mother/guardian    
Name  
Address  
Occupation  
Home phone  
Work phone  
Cell phone  
 

Father/guardian    
Name  
Address  
Occupation  
Home phone  
Work phone  
Cell phone