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Student information
First (Given) name*
Preferred name
Middle name
Last (Family) name*
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)
- Yes
Birth date

MM slash DD slash YYYY
Student Type*
Parent information
Parent/guardian first name
Parent/guardian last name
Parent/guardian email
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Parent/guardian first name
Parent/guardian last name
Parent/guardian email
Student school information
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
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- Pacific Islander
- White or Caucasian
Primary academic interest
Secondary academic interest
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