Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Preferred Home Resource Center (Westlake or Oxnard)
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Please Select
Westlake
Oxnard
Grade(s) Your Student(s) Will Be In
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Please Select
Traditional Program (K-12)
Credit Recovery/Alternative Program (9-12 only)
Interest for 24-25 school year or other? Specify school year.
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Grade(s) Your Student(s) Will Be In
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How did you hear about us?
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Your Student's Passions
Your Student's Strengths
Areas Your Student(s) Need Help In
Your Student's Special Needs (if applicable)
Additional Information About Your Student(s) (optional)
Please verify that you are human
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