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* 1. What is your full name?

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* 2. What is your UC email address?

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* 3. What is your phone number

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* 4. What is your major and/or program of college? (Please list department and college, if applicable.)

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* 5. Describe why you want to participate in the "Experiential Learning Collaboratory: Generation Ali" class? (In your answer, be sure to include any unique experiences you may have that would add value to the class.)

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* 6. Optional Question: Is there anything else you’d like to share about yourself and/your experiences?

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* 7. The Fall '14 section of this class is scheduled to meet 1 time per week, on Friday mornings from 9:05 AM - 12:10 PM. Does this fit with your current class schedule for fall, or would you be able to adjust your schedule to make it possible?

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