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Student Application
Personal Information
First Name *
Middle Name
Last Name *
Current Mailing Address *
Current Mailing City *
Current Mailing State and Zip Code *
Email Address
Preferred Phone Number *
Preferred Phone Number Type *
Alternate Phone Number
Alternate Phone Number
Date of Birth *
MM/DD/YYYY
Place of Birth *
Gender *
Marital Status *
Do you have any children? *
If yes, how many?
Racial or Ethnic Origin *
Required
If any, what tribe(s) are you a part of?
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