Fillable Youth Services Student Profile Sheet (St Regis Mohawk Tribe)

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Youth Services Student Profile Sheet (St Regis Mohawk Tribe)

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Version 11/2020
Youth Services
Student Profile Sheet
Name: DO.B.:
#1 - Parent/Guardian Name: Relationship to Student:
Contact Information:
Phone -
E-mail -
Mailing Address (if not same as Students):
#2 - Parent/Guardian Name Relationship to Student:
Contact Information:
Phone -
E-mail -
Mailing Address (if not same as Students):
Please Note: By signing the Applicant’s Agreement of Understanding and Release of
Information of the Tribal Learning Assistance Program application, the assigned Youth
Services Educational Specialist will obtain class schedule and current grades from the school
noted below.
Academic Year:
Current Grade Level:
Expected Graduation Date:
Guidance Counselor’s Name:
School:
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Youth Services Student Profile Sheet (St Regis Mohawk Tribe)

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Completed 27 January 2021

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