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Student Information

COLLEGE BLOCK is a program that serves our community. "We do your college paperwork for you!" Just fill out this form and we will contact you to set up an appointment.
Write a description of your survey here. Select any question below to change it. Then add questions as needed.

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* 1. What is the student's first name?

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* 2. What is the student's last name?

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* 3. What is the student's birth date?

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* 4. How challenging is it to fill out and keep up with college paperwork? The scale is 1 to 10, 1 being really easy, 10 being super difficult.

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* 5. What city does the student live in?

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* 6. What is the student's zip code?

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* 7. What is the student's email?

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* 8. What is the student's phone number?

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