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Spokane Virtual Learning - Fall 2009 Registration

Student Information:
First Name
 
Student e-mail
M.I.
 
Parent/home e-mail
Last Name
 
Ethnicity
Home phone
ex-509-123-4567
 
Date of birth
/ /
M / D / YEAR
Parent work phone
ex-509-123-4567
 
Gender
Cell phone
     
Mailing Address:
Street 1
 
State
Street 2
 
Zip
City
 
School Information:
Current school
 
Counselor name
If your school was not listed,
please identify
 
Grade level
2009 - 2010
ID Number
(if Known)
 
Do you have an IEP?

Yes (leave blank for no)