1. Biographical Information

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20% of survey complete.


* 1. What is your proposed major at Louisiana Tech?

* 2. Please describe your race/ethnicity.

* 3. What is your gender?

* 4. Name and Contact Information

* 5. First Name

* 6. Last Name

* 7. CWID - Campus Wide ID Number

* 8. Email Address

* 9. Phone Number

* 10. Address while attending LA Tech

* 11. Address while attending LA Tech 2

* 12. City/Town

* 13. State

* 14. Zip/Postal Code

* 15. Date of Birth (ALL dates need to be in this format: 00/00/0000)

* 16. Place of Birth

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