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YSU Summer In America Registration
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Applicant Information
Legal Last Name:
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Your answer
First Name:
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Your answer
Address Line 1:
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Your answer
Address Line 2:
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City/Town:
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Province/State:
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Postal/ZIP/Pin Code:
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Country:
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Whatsapp/WeChat ID:
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Cell Phone:
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Email Address:
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Gender
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Female
Male
Prefer not to say
Other:
Age:
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Your answer
Date of Birth (MM/DD/YYYY):
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Country of Citizenship:
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City of Birth:
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Country of Birth:
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Country of Passport:
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Your answer
Passport Number:
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Your answer
Passport Expiration Date (MM/DD/YYYY):
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Your answer
Applicant Medical Information
Your answer
Do you suffer from any medical condition/disability that may affect your studies? (Answers are for our department knowledge and preparation only, and will not influence your acceptance into the program.)
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Yes
No
If yes, please specify from the following:
Hearing
Learning
Mobility
Visual
Medical
Other:
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T-Shirt Size:
Extra Small (XS)
Small (S)
Medium (M)
Large (L)
Extra Large (XL)
Other:
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Name of Home University:
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Would you like to add the optional program to Washington D.C. and New York City (includes hotel accommodation & transportation)?
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YES (July 31- August 3, 2020: +$600)
NO
By typing my name here, I hereby declare that I have provided accurate information in this form about myself ot the best of my ability.
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Summer In America Deposit
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