Student Interest Form

HBCU Early College Prep Interest Form

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Cell Student Parent/Guardian

Student Name *

Current School *

Student Cell Phone Number

Student Email Address *

Parent/Guardian Name *

Parent/Guardian Cell Phone Number

Parent/Guardian Email Address *

Questions/Comments

Email:
ajohnson64@schools.nyc.gov
Address:
88-15 182nd Street, Jamaica, NY 11423
Phone:
(347) 455-9606
Fax:
(347) 455-9624