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Student Name

Student DOB

Gender

Grade Applying For

Start Date

Parent/Guardian 1 Name

Relationship

Parent/Guardian 2 Name

Relationship

Previous school attended (if any)

Special interests, talents, or areas of strength

Areas where student may need extra support

Has your child been evaluated for learning differences?

Yes

If yes, please provide more info so we can make sure your child is supported

Why do you want to be apart of Murray Meadow Academy?

Parent / Guardian Statement: I understand that submission of this application does not guarantee enrollment. I certify that the information provided is complete and accurate to the best of my knowledge. Print Name:

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