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* 1. Your Name

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* 2. Your K Number

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* 3. Your Chemeketa Student Email Address
This should be in the format ____________@my.chemeketa.edu

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* 4. Do you currently participate in any of these programs?

Please select only programs you are currently enrolled in to help us determine the appropriate device for you.

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* 5. At which location would you like to checkout the device?

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