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- Applicant's Pronouns (select those that apply):*
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- Do you identify as an individual within the BIPOC community? - All information will be kept confidential in accordance with federal law and does not affect your eligibility for our programs, we collect this information to provide participant demographics to our funders.*
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- TYPE OF SPOT: Please indicate the type of spot you are applying for:*
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- If you selected "Scholarship" for TYPE OF SPOT above, please select all that apply.
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- Input Todays Date*
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- Participants Date of Birth*
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- Does your child suffer from any of the following?*
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- Please select any of the following non-prescription medications you give permission for your child to receive if needed.*
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- Date of Submission*
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- Should be Empty: