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Student information

First (Given) name*

Preferred name

Middle name

Last (Family) name*

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Email address*

Address Line 1*

Address Line 2

City*

State*

Province

Country*

Zip/Postal code*

Phone Number

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(U.S. or Canada only)

Birth date

Student Type*

Parent/guardian first name

Parent/guardian last name

Parent/guardian email

Parent/guardian first name

Parent/guardian last name

Parent/guardian email

High school name

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College name

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CEEB code

Entry term*

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Please check all that apply:

African American
Hispanic or Latino
American Indian or Alaska Native
Asian American
Southeast Asian (includes, but is not limited to Bhutanese, Burmese, Cambodian, Cham, Hmong, Laotian, Mien, and Vietnamese)
Pacific Islander
White or Caucasian

Primary academic interest

Secondary academic interest

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