Student Information for Adoption
Today's Date
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Month
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Day
Year
Date
Student Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
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Area Code
Phone Number
Parent/Guardian Phone Number
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Area Code
Phone Number
College Name
Year of High School graduation
Expected month/year of college graduation
Major
Address at school
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
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Area Code
Phone Number
Student E-mail
Student Birth Date
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Month
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Day
Year
Date
Any food Allergies or Foods to avoid?
Any questions, changes in student status/address, contact Kyle Kokan 412-780-9980 or kkokan96@gmail.com
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