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* 1. What is your last name?

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* 2. What is your first name?

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* 3. Please provide your email address.

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* 4. Please provide your phone number.

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* 5. Will you be 16 years of age or older before beginning work in the research lab setting? (You must be between 16 and 18 years old to continue processing. If you are already 18 or older, you will be processed as an adult through your lab). 

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* 6. What is the name of your High School?

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* 7. What is your current High School level?

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* 8. Who is your Research Mentor? (Please note that this is not a mentor-matching program, you must already have a mentor who has agreed to host you in their lab on campus. If you do not have a mentor, please see our directory to find a mentor. https://directory.uthscsa.edu/ )

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* 9. Primary Emergency Contact

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* 10. If your Primary Contact has another Phone Number, please provide below.

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* 11. If your Primary Contact has an email address, please provide below.

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* 12. Secondary Emergency Contact

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* 13. If your Secondary Contact has another Phone Number, please provide below.

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* 14. If your Secondary Contact has an email address, please provide below.

Thank you for registering for the upcoming Minors Conducting Research in the UTHSCSA Workplace.

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* 15. Please check your corresponding program?

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* 16. My expected visiting dates are: (mmdd-mmdd)

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* 17. I will be needing a parking permit  during this time

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