Jr/Sr Self Eval Spring 2011
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1. General Information

Please update your contact information. Name (First, Last):
Address:
Address 2:
City/Town:
State:
ZIP:
Email Addresses:
Phone Number:

Please enter the following information Your mentor's name
Lab Phone Number
School Major

	Present Class Standing	Program
Selection	What is your current class standing and what program in which you are currently participating? Selection Present Class Standing	Program