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Page 1

If your student is currently enrolled in an SPPF program, please use the exact first name, last name and date of birth found in ProCare to complete this screen.

Student's First Name

Student's Last Name

No Suffix Please.

Student's Birthdate

Has this student ever applied to or been admitted to an SPPF Program?

YesNo

Has another student in this household ever applied to or been admitted to an SPPF Program?

YesNo

Hidden Fields

account and contact list

prior account id

prior primary contact

second parent contact id

child firstname format

child lastname format

parent firstname format

parent lastname format

Page 2

Please enter the information below for this student’s primary caregiver. This may be a parent, grandparent, other relative or legal guardian. This is the first person we will contact about the student in the event of an emergency or to discuss progress and attendance.

Primary Caregiver's First name

Primary Caregiver's Last Name

Primary Caregiver's Birthdate

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