Primary Texts Registration Form
Please take a moment to fill out this form to register for the program. We will be in touch with you soon!
First Name *
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Last Name
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Local Address *
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Permanent Address
Please enter an address where we can send your certificate when earned!
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Month Registering
Year Registering *
Semester Registering *
Class Rank *
WID *
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Email *
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Major *
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Are you an Honors Student? *
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