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Service Hours Questionnaire

indicates a required answer

1. *

Name:

2. *

1. What periods will you be attending Co-Op?

 (1 required)
1st Period 9:00 - 9:55 2nd Period 10:00 - 10:55
3rd Period 11:00 - 11:55 Lunch 12:00 - 12:40
4th Period 12:45 - 1:40 5th Period 1:45 - 2:40
6th Period 2:45 - 3:40
3. *

2. I want to help as...


Use your Ctrl & Shift keys to select multiples.
4. *

3. Please specify details for your answer to Question 2. (Ex: Do you want to help a certain period? Do you want to help in a specific class?)

5. *

4. Do you have any limitations or specific needs/requirements? (Ex: I will be caring for a small baby. I cannot stand for extended periods of time. I cannot handle certain chemicals.)

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