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Student Information
* Required Information
User Name
 *
First Name
 *
Last Name
 *
MI
Social Security Number
 * (Use 9 digits only)
Date of Birth
 * (mm/dd/yyyy)
Sex
 *
Martial Status
 *
Student Type
  

Local/School Address
Street1
 *
Street2
  
City
 *
State
 *
zip
 *
Local/School Phone
 *

Permanent Address
Street1
 *
Street2
  
City
 *
State
  
zip
 *
Country
 *
Home Phone
 *

Next of Kin
First Name
 *
Last Name
 *
Relationship
  

Kin's Home Address
Street1
 *
Street2
  
City
 *
State
  
zip
 *
Home Phone
 *

Kin's Business Address
Street1
  
Street2
  
City
  
State
  
zip
  
Business Phone
  
 
 

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