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2012 Oakland University and Arts & Technology Academy of Pontiac ESL Grades 1 - 12 Summer Program Registration

Please complete the entire form and submit no later than May 1, 2012.


  
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Student name:
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Parent/guardian's name:
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Phone number where parent/guardian can be reached while class is in session:
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Parent/guardian email address:
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Street address:
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City:
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Zip code:
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Country of origin:
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Student's first language:
List any allergies or health issues that the student has:
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Name of district and school:
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Student's 2012 - 2013 grade level:
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School phone number:
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School address:
ESL teacher's name or referring person's name:
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ESL teacher's (or referring person's) phone number:
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ESL teacher's (or referring person's) email address:
ESL teacher's or regular teacher's comments about the student's English language skills and proficiency level:
*
Student's ELPA score:
*Security Code:

For additional information please contact: 


Rebecca Gaydos

Email: gaydos@oakland.edu

Department of Linguistics

Oakland University 

322 O’Dowd Hall 

Rochester, Mi., 48309

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