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School Name*
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First Name*
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Last Name*
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E-Mail Address*
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Phone Number*
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Fax Number
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Grade Level*
Please provide the grade level.

Number of Students*
Please provide the number of students.

Assignment Due Date*
Please provide the assignment due date.

Description of the Assignment
Please provide the description of the assignment.

Materials students may use*

Please place a check next to the materials that students may use.

Will the students be working in groups?*

Please indicate whether or not the students will be working in groups.

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