BRAIN FOOD

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-- Please Choose --9:00 AM9:20 AM9:40 AM10:00 AM10:20 AM10:40 AM11:00 AM11:20 AM11:40 AM12:00 PM12:20 PM12:40 PM1:00 PM1:20 PM1:40 PM2:00 PM2:20 PM2:40 PM3:00 PM3:20 PM3:40 PM4:00 PM4:20 PM4:40 PM5:00 PM

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Student's Name:

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Will the student attend virtually or in person at our center?
-- Please Choose --VirtuallyIn personEither/both

Has the student attended BLAST previously?
-- Please Choose --YesNoUnsure

Which subject(s) does the student need help with?

When do you want the student to start BLAST?

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Student's Name:

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Student's School:

Which class is the student enrolling in?
-- Please Choose --March 11 SAT: Class starting on 2/12March 11 SAT: Class starting on 2/14May 6 SAT: Class starting on 4/2May 6 SAT: Class starting on 4/11June 3 SAT: Class starting on 5/7June 3 SAT: Class starting on 5/9February 11 ACT: Class starting on 1/15February 11 ACT: Class starting on 1/17April 15 ACT: Class starting on 3/19April 15 ACT: Class starting on 3/21June 10 ACT: Class starting on 5/14June 10 ACT: Class starting on 5/16Let's Talk Tests: Week of September 28Let's Talk Tests: Week of October 12Applications Workshop: September 24Private School Test Prep: 10/12-11/30Private School Test Prep: 10/13-12/1

Has the student taken the test previously?
-- Please Choose --YesNoNot Applicable

Has the student done any other type of test prep?
-- Please Choose --YesNoNot Applicable

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Your Name:

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City, State, Zip Code:

Student's Name:

Student's Age:

Student's Grade:

Student's School:

Are you interested in virtual or in-person tutoring?
-- Please Choose --VirtualIn personEither/both

Does the student have an IEP/504 or other special accommodations?
-- Please Choose --YesNoUnsure

Is the request for Test Prep / Subjects / Other?
-- Please Choose --Test PrepSubjectsOther

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