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Toll Free Number: 1-800-246-5061

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Student First Name: *

Student Last Name: *

Parent/Guardian First Name: *

Parent/Guardian Last Name: *

Have you applied for EFA at ArkansasEFA.com? * Yes No

Have you selected Red Comet as your provider in ClassWallet? * Yes No

Student Home Address: *

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State: *

Zip Code: *

Primary Contact Phone: *

Alternate Contact Phone: *

Secondary Contact Phone: *

Alternate Secondary Contact Phone: *

Email: *

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