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1.
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Teacher name and contact information (please use school email and phone number):
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*2.
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(Maximum response 255 chars, approx. 5 rows of text)
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*3.
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*4.
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(Maximum response 255 chars, approx. 5 rows of text)
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*5.
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*6.
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*7.
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Check any of the following needs that apply to your students
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*8.
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*9.
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