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Student Information
First Name
*
Last Name
*
MI
Address 1
*
Address 2
Phone
Email Address
City
*
State
*
Zip Code
*
Race/Ethnicity
*
African American
Asian
Caucasian
Hispanic
Native American
Other
Marital Status
*
Married
Separated
Divorced
Domestic Partners
Single Parent
Unmarried
Residence Status
*
US Citizen
US Permanent Resident
International Student
Major
*
Academic Records
High School
*
City
*
State
*
GPA
*
ACT
SAT
Please list any awards or honors that you have received.
*
Please list any sports, extracurricular, or community service activities you have participated in.