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Mr.
Ms.
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First_name: |
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Last_name: |
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Address_line1: |
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Address_line2: |
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City: |
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County: |
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State: |
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Zip Code: |
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Home Phone: |
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Ethnicity (Optional): |
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Name of present high school/college? |
(If none currently, please provide most recently attended.) |
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Graduation Year: |
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Academic program interest: |
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I plan to enter SRU: |
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I will enroll as a: |
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My email address is: |
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Within a few days, you will receive informative materials from
the Admission Office that will give you the opportunity to begin
your bright future at The Rock.
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