STUDENT INFORMATION

Please complete the following section and ensure all information is current and accurate. Failure to provide complete and accurate responses will result in the program request being removed from further review.

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* Enter your first name, last name, and middle initial:

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* Enter your address:

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* Enter your phone number (Format 111-111-1111):

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* Enter your email address:

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* Are you officially accepted or enrolled in a major?

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* If yes, provide the institution and the state where you are currently accepted or enrolled:

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* Enter your current major:

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* If applicable, enter the name of the Concentration, Option, Specialization, or Track (if none, type N/A):

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