| Contact Information |
Please enter your data accurately and provide your full name and complete address.
* = Required Field
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| * Legal First Name (Given Name): |
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| Middle Name: |
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| * Last Name (Family Name): |
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| * Address: |
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| * City: |
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| State/Province: |
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| * Postal Code: |
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| Country: |
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| * Email Address: |
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Home Telephone Number (US & Canada):
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Mobile/Cell Telephone Number (US & Canada):
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International Telephone Number (include country code):
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| Gender: |
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Ethnic background: Do you consider
yourself Hispanic or Latino? |
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What is your racial background?
(Check one or more) |
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American Indian/Alaskan Native
Asian
Black or African American
Cape Verdean
Native Hawaiian or other Pacific Islander
White
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| Are you an international student? |
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Are you a current or former member
of the US Armed Forces? |
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| Academic Interest |
| * Major of Interest 1: |
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| Major of Interest 2: |
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| Interests: |
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Athletics
Arts
Honors Program
Residence Life
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| Additional Information |
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If not found, please enter name of school:
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* High School Graduation Year
(actual or anticipated): |
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If not found, please enter name of school:
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| How did you hear about us?: |
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Do you need assistance with obtaining
a visa to study in the United States? |
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