Student Name*
Address*
City*
State*
Zip
Country
Date of Birth*
(mm/dd/yyyy)
Current School*
Current Grade Level*
Expected Date of Enrollment*
(mm/dd/yyyy)
Primary Language*
Gender*
female
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Town of Legal Residence*
Please indicate the town in which you currently reside:
Bozrah
Brooklyn
Canterbury
Franklin
Lisbon
Norwich
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Sprague
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Town of Legal Residence - Other
Primary Parent/Guardian Name*
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Phone*
Email
Preferred Contact
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email
Interests*
Please check all areas that you would like more information about:
Campus Tour
Arts
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AP Courses
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ELL Program
Special Education
9th Grade Program
Questions
Do you have any questions about any of our current programs?
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