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First Name
Last Name
High School you attend:
What do you wish to learn in this program?
Phone Number
School Email
Personal Email
Emergency Contact Full Name
Emergency Contact Phone Number
Emergency Contact Email Address
Do you have access to your transcript?
Yes
No
I dont know
I can get it from my counseler
Any dietary restrictions?
Yes
No
What major/career path interests you? (If unsure, write N/A)
Do you currently have any plans to pursue any of the options below:
2-year college
4-year college
Not sure
I want to, but don't know if I can
Other
Gender: (This question is for housing purposes)
Female
Male
Gender Variant/Non-Conforming
Transgender Male
Transgender Female
Prefer not to answer
Any questions, comments or concerns:
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