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Student Name
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Grade Level:
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Please complete the entire form.
Select your 1-2-3 choice for Xblock.
DO NOT choose the same Xblock class 3 times. This will not ensure that you get the course you want.
We will make every effort to place you in your first choice however we cannot make any guarantees.
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First Choice:
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Second Choice:
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Third Choice:
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Check only if this is a CORRECTION:
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