Student's Information
*First Name:		*Last Name:
*Date of Birth:	010203040506070809101112 / 01020304050607080910111213141516171819202122232425262728293031 / 19781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009	*Current Grade Level:     010203040506070809101112
*School Name:
Contact Information
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*Email Address:
Address Information
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Additional Information
Does student have any family ties to Magnificat?		Yes  No
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