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* Type of School:
Public School    Private School    Home School    Higher Education Institution    Other

* School District:

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* What grades will use the modules?
(Select all that apply)
6    7    8    9    10    11    12    Other

* Number of uBEATS student accounts needed?
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Affiliated with uBEATS through... - Select One - NCHSE PTCB/PTEC HOSA My State's Department of Education

Questions? Email ubeats@unmc.edu.