Information Request Form

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Personal Information
Birthdate
Are you Hispanic/Latino (including Spain)?
Race
Contact Information
*Permanent Home Address




Is your mailing address different from your permanent home address?
*Mailing/Boarding Address (if different from home address)




Academic Information
Date of HS Graduation (mm/yyyy approximate)
If you will be entering college in 2013, please select one of the following options:
I am a candidate for (please select appropriate box)
I am a candidate for (please select appropriate box)