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Connection High School Choose Gang Free Referral Form
This form must be completed for every student who is referred to the Choose Gang Free Program. A new referral form must be filled out for each student.
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* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Referrer's Name (First and Last):
*
Your answer
Referrer's Agency/Employer
*
Granite School District
I am a student.
I am a parent.
Other:
Referrer's Phone Number
*
Your answer
Referrer's Email
*
Your answer
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