Indian Education Center Intake Survey

Parent or Legal Guardian Information
Parent/Legal Guardian Contact Information
Second Parent/Legal Guardian Contact Information
Which two people would you like to be contacted in the case of an emergency?
Emergency Contact/Release Information
What is the best way to contact you/the emergency contacts in an emergency?
Please select any household types that apply to you.
How many people live in your household including yourself?
Please select your housing situation.
Do you live on a Reservation or Rancheria?
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