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Student’s name



Student’s grade (if currently between grades, round up)
—Please choose an option—8th9th10th11th12th


School



Student’s phone number (optional)



Student’s email address (optional)


Note: Team mentors always include parents in private communications with students. Please use a non-school-issued address, as many schools block incoming messages.

Parent’s name



Parent’s phone number (optional)



Parent’s email address



Who referred you (if anyone)?



Questions or comments