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Ip Code State Name & Address of H.S. Attended Telephone Type of H.S. (circle) Public Name & Address Of Institution You Plan To Attend Private Year in School (circle) Minor BIA H.S.Graduation Date GED HSED Enrollment Status (circle) 1st 2nd 3rd 4th 5th Major Course of Study Date Rec'd. Education Dept. Full Time Term Attending (circle) Part Time Fall Expected Degree (circle) AA BA BS MA Winter Spring Summer Expected Graduation Date Other Father's.

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