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Contact Information
First Name
Last Name
Phone xxx-xxx-xxxx
Email Address
Zip Code
What is your role? Select all that apply.
Parent/Guardian
Teacher
Administrator
Elected Official
Community Member
Business Organization
Non-Profit Organization
What school(s) are you affiliated with as a parent? Select all that apply up to eight.
Are you interested in being a RootEd representative?
Yes
No
What school are you a teacher/administrator at? Select all that apply, up to five.
Are you interested in having a RootEd representative on your campus?
Yes
No
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