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Boiler Back Home Interest Form
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Name (Last, first)
Your answer
Purdue Email
Your answer
Campus Location
Indianapolis
West Lafayette
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Major
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Aeronautical and Astronautical
Agricultural
Biological
Biomedical
Chemical
Civil
Computer
Construction Engineering and Management
Electrical
Environmental and Ecological
Environmental and Natural Resources
Industrial
Interdisciplinary
Materials
Mechanical
Motorsports
Multidisciplinary
Nuclear
Hometown and State
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High School Name
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Are you interested in participating in Boilers Back Home?
Yes
No
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If you selected yes, please select which breaks you would be interested in participating in.
Winter Break
Spring Break
Summer Break
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