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* 1. Name (First, Middle, and Last)

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* 2. Name you prefer to be called (if different from first name)

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* 3. Date of Birth

Date / Time

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* 4. School Name (Please write out the entire name, not just initials)

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* 5. GPA

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* 6. Please list any extra-curricular activities you are involved in and describe your roles.

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* 7. Please upload a recommendation letter from a guidance counselor or teacher.

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* 8. Please upload an original essay (minimum 1000 words) describing the facets of what you believe makes life better for those in your community and how you commit yourself to achieving that goal.

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