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STUDENT First Name

STUDENT Preferred Name (only if different than first name)

STUDENT Last Name

STUDENT Birthdate

STUDENT Email Address

STUDENT Cell Phone Number

Entrance Status

Entry Term

Name of College or University previously attended and/or currently attending (please list all if more than one):

PARENT/GUARDIAN Email Address
We like to have a parent/guardian email address on file to keep parents updated on important events and deadlines as well.

STUDENT Mailing Address

Country

Street

City

Region

Postal Code

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