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* 1. Name:

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* 2. Phone Number

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* 3. Email address

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* 4. Local address or dorm name

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* 5. Criminal record

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* 6. What is your major/minor?

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* 7. What year are you?

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* 8. Please list prior work experience. Include approximate dates of employment and briefly describe responsibilities.

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* 9. Please describe yourself in 5 sentences or less.

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* 10. Please list any on campus activities or organizations you are involved with.

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