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| * Name |
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| * Date of Birth |
Use MM/DD/YYYY format. |
| * Email |
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| * I plan to enter: |
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| * I will be a: |
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| I would like to receive more information on the following: |
| I am interested in need-based financial aid: |
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I am interested in studying:
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to select more than one interest. |
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If other: |
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| Current Mailing Address/Phone |
| Street Address, Line 1 |
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| Street Address, Line 2 |
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| City |
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| State |
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| Zip Code |
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| Country |
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| Telephone: |
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| Optional |
| Current (or last) school name (no abbreviations): |
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| Current (or last) school state: |
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Current (or last) school CEEB code:
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| I am a US citizen/ Green Card holder |
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| Are you Hispanic or Latino? |
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| What is your race? (optional) |
American Indian or Alaska Native |
| Select one or more with which you identify: |
Asian |
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Black or African American |
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Native Hawaiian or other Pacific Islander |
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White |
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