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* 1. First Name

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* 2. Last Name

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* 3. GEAR UP High School

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* 4. What year did you graduate from high school? (Ex. 2016)

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* 5. Email address

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* 6. Mobile Phone Number (Please include area code.)

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* 7. What is your current standing in college

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* 8. Name of college currently attending or previously attended? Type out full name of college (Ex. Idaho State University)

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