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APPLICATION

Student Information

First Name

Last Name

Email

Birth Date

Code

Phone (optional)

Grade Level *

Type *

Guardian Information

Guardian's First Name *

Guardian's Last Name

Guardian's Email *

Code

Guardian's Phone Number *

Home Address

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Immersion Academy

4010 Barranca Parkway

Ste. 252, Rm. 2521

Irvine, CA 92604

info@immersionacad.com
949-993-8333

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