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Conference Request Form

LOS ANGELES UNIFIED SCHOOL DISTRICT

Roy Romer Middle School, Gifted & STEM Magnet

6501 LAUREL CANYON BOULEVARD, NORTH HOLLYWOOD, CALIFORNIA 91606
TELEPHONE: (818) 505-2200 FAX: (818) 761-9343

Today's Date:

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Student Information

Student First Name:*

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Student Middle Name:

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Student Last Name:*

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Birthdate:*

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Parent/Guardian Information

Parent/Guardian First Name:*

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Parent/Guardian Last Name:*

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Phone Number:*

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Parent/Guardian Email:

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I am requesting a conference by:*

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Phone Conference

In-Person Meeting

E-Mail

Teacher Name, Counselor or Staff:*

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Purpose of Request:*

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Behavior

Grades

Personal

Translation Requested/Language

Other:

In a few words explain your matter:*

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Verification Code:*

Please enter characters in the image above. Letters are case-sensitive.

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* Indicates required field.