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Student/Alumni/Community Member Registration

Full Name

First

Last

Preferred Name

Student ID

Current students and alumni please complete.

Current students please use your school email address.

Alternate Email

Phone Number

(###) ###-####

Current Address

Please provide as much information as possible

Street Address

Dependent Locality

City

State

Zip

Country

Academic Information

Applicant Type

Degree Level

List the highest degree level you are currently pursuing or received.

Graduation Date

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Credits Completed

Major(s)

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