Alternative Education Activation Form


Legal First Name*:
 Legal Middle Name:
 Legal Last Name*:
Last District Attended*:
 Other:
Date of Birth*:
- -
Gender*:
Grade*:
Student Residence*:
    Street Address:
    City:
    Zip Code:
 
Initial Enrollment Date* (mm/dd/yyyy):
- -
Activation Requested By*:
Comments:

 



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Copyright Charlevoix - Emmet Intermediate School District 2008
Last revised: May 7, 2009