1. Biographical Information

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20% of survey complete.


What is your proposed major at Louisiana Tech?

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

Please describe your race/ethnicity.

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* 2. Please describe your race/ethnicity.

What is your gender?

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* 3. What is your gender?

Name and Contact Information

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* 4. Name and Contact Information

First Name

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* 5. First Name

Last Name

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* 6. Last Name

CWID - Campus Wide ID Number

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* 7. CWID - Campus Wide ID Number

Email Address

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* 8. Email Address

Phone Number

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* 9. Phone Number

Address while attending LA Tech

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* 10. Address while attending LA Tech

Address while attending LA Tech 2

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* 11. Address while attending LA Tech 2

City/Town

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* 12. City/Town

State

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* 13. State

Zip/Postal Code

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* 14. Zip/Postal Code

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

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

Place of Birth

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* 16. Place of Birth

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