Northwest Tri-County Intermediate Unit 5

Personal Information

First Name *

Middle Name

Last Name *

Date of Birth *

Student's E-mail Address *

Student's Phone

Student's Address *

Are you a returning RCI Student? *

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Current Grade: *

District: *

Graduation Month/Year:

List alternate courses below:

List alternate courses below:

First Name *

Middle Name

Last Name *

Parent's Phone Number

Parent's E-mail Address *

Parent's Address *

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