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* 1. Please list the student's initials:

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* 2. Please list the student's educational and medical diagnoses.

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* 3. Is the student male or female?

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* 4. How long has the student received GNETS services?

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* 5. What are your initials?

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* 6. What is the highest level of school you have completed or the highest degree you have received?

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* 7. Please select the category that most appropriately describes you.

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