Minnesota Private Pay - Venture Upward

Parent Name*

First Last

Phone*

Email*

Physical Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address

Same as Physical Address

Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Add Another 2

Add Another Student

Second Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Add Another 3

Add Another Student

Third Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Add Another 4

Add Another Student

Fourth Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Add Another 5

Add Another Student

Fifth Student Name*

First Last

Student Grade level as of September 1, 2023*

Birthday*

Gender*

Male
Female

Note: Only five students can apply at a time. If you have more students, please fill the application out a second time.

Venture School Location

Please choose your location

Additional Comments or Questions

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