Name:
|
Date:
|
Your Address at
College:
|
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Email Address:
|
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Permanent
Address:
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Street: City:
|
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State:
Zip:
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Telephone
Number(s):
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Local: |
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Permanent:
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Married?
Yes No
|
U.S. Citizen or
Permanent Resident?
Yes No
|
College
Name:
|
Classification:
Freshman
Sophomore
Junior Senior
|
Projected
Graduation Date:(mm/yyyy)
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Major:
|
GPA(s):
|
Overall GPA: |
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Major GPA:
|
Gender:female male
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Ethnicity:
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Is English the only
language spoken at home?Yes No
|
Were you raised in a
single parent home? Yes No
|
Did you attend public or
private high school?Public
Private
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What is your parents'
highest grade completed?4-8
9 10
11 12
13 14
15 16
16+
|
Is your high school
rural,
urban or suburban? rural urban suburban
|
Did you take AP courses
in
high school? Yes No
If yes, how many?
|
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What was the last math
course taken in high school? |
| How did you
hear
about SUMSRI?: |
Website Professor
Departmental
newsletter/bulletin board National
Meeting Fraternity/Sorority
Other
|