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*First Name
*Preferred First Name/Nickname
Middle Initial
*Last Name
*Street Address
*City
*State	-- AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS FM GU MH MP PW PR VI AA AE AP AB BC MB NB NL NT NS NU ON PE QC SK YT
*Zip Code
County (if in Missouri)	None (not from Missouri) ADAIR ANDREW ATCHISON AUDRAIN BARRY BARTON BATES BENTON BOLLINGER BOONE BUCHANAN BUTLER CALDWELL CALLAWAY CAMDEN CAPE GIRARDEAU CARROLL CARTER CASS CEDAR CHARITON CHRISTIAN CLARK CLAY CLINTON COLE COOPER CRAWFORD DADE DALLAS DAVIESS DEKALB DENT DOUGLAS DUNKLIN FRANKLIN GASCONADE GENTRY GREENE GRUNDY HARRISON HENRY HICKORY HOLT HOWARD HOWELL IRON JACKSON JASPER JEFFERSON JOHNSON KNOX LACLEDE LAFAYETTE LAWRENCE LEWIS LINCOLN LINN LIVINGSTON MC DONALD MACON MADISON MARIES MARION MERCER MILLER MISSISSIPPI MONITEAU MONROE MONTGOMERY MORGAN NEW MADRID NEWTON NODAWAY OREGON OSAGE OZARK PEMISCOT PERRY PETTIS PHELPS PIKE PLATTE POLK PULASKI PUTNAM RALLS RANDOLPH RAY REYNOLDS RIPLEY ST. CHARLES ST. CLAIR ST. FRANCOIS STE. GENEVIEVE ST. LOUIS ST. LOUIS CITY SALINE SCHUYLER SCOTLAND SCOTT SHANNON SHELBY STODDARD STONE SULLIVAN TANEY TEXAS VERNON WARREN WASHINGTON WAYNE WEBSTER WORTH WRIGHT I Don't Know
*E-mail
Phone Number (xxx-xxx-xxxx)
Cell Phone Number (xxx-xxx-xxxx)	Please check if you accept text messages
Gender	Female   Male
Ethnicity	Are you of Hispanic or Latino descent? Yes   No Please check all that apply American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
*High School
High School Code (Look it up!)
City and State of High School
*Year of Graduation	2011 2012 2013 2014 2015
Anticipated Start Term	Spring 2012 Fall 2012 Spring 2013 Fall 2013 Spring 2014 Fall 2014
College/University attended:
Academic Programs of Interest:
First major	-- Accounting Art Art Education Biochemistry Biology Biology Education Business Administration Business - Entrepreneurial Leadership Business - International Business French Business - International Business Spanish Chemistry Chemistry Education Communication Communication/Theatre Economics Education/Elementary Education/Secondary English English Education English/Literature English/Writing French French Education History International Relations Mathematics Mathematics Education Music Music - Church Music Music - Composition Music Education - Instrumental Music Education - Vocal Music Performance Music Theory Non-Profit Leadership Nursing Organizational Communication Oxbridge English Language and Theory Oxbridge History Oxbridge History of Ideas Oxbridge Institutions and Policy Oxbridge Molecular Biology Oxbridge Music Philosophy Physical Education Physics Physics Education Political Science Psychology Recreation and Sport Religion & Culture Rhetoric and Political Communication Science Education Social Studies Education Spanish Spanish Education Speech Education Theatre Theatre Education Undecided
Optional second major	-- Accounting Art Art Education Biochemistry Biology Biology Education Business Administration Business - Entrepreneurial Leadership Business - International Business French Business - International Business Spanish Chemistry Chemistry Education Communication Communication/Theatre Economics Education/Elementary Education/Secondary English English Education English/Literature English/Writing French French Education History International Relations Mathematics Mathematics Education Music Music - Church Music Music - Composition Music Education - Instrumental Music Education - Vocal Music Performance Music Theory Non-Profit Leadership Nursing Organizational Communication Oxbridge English Language and Theory Oxbridge History Oxbridge History of Ideas Oxbridge Institutions and Policy Oxbridge Molecular Biology Oxbridge Music Philosophy Physical Education Physics Physics Education Political Science Psychology Recreation and Sport Religion & Culture Rhetoric and Political Communication Science Education Social Studies Education Spanish Spanish Education Speech Education Theatre Theatre Education Undecided
Optional minor	-- Art History Biblical Studies Chemistry Christian Tradition and Thought Classical Humanities Coaching and Performance Enhancement Communication Economics Entrepreneurial Leadership French History Japanese Area Studies Mathematics Music Nonprofit Leadership Philosophy Physics Pre-Medicine Recreation & Sport Spanish Studio Art Theatre Nonprofit Leadership Certification Pryor Leadership Studies Certification
Pre-Professional Programs	-- Dentistry Engineering Forestry and Environmental Management Law Medicine Ministry Occupational Therapy Physical Therapy Veterinary Medicine
Co-curricular Interests:
Student Clubs & Organizations (use the control [Ctrl] key to select multiple options)	Academic Clubs/Honor Societies American Humanics Art Bass Guitar Bassoon Cello Civic Organizations Clarinet Classical Guitar Debate Diversity Organizations Fellowship Christian Athletes Flute Forensics French Horn Greek Life Guitar Harpsichord Intramural Sports Jazz Band Leadership Mascot Music - Instrumental Music - Vocal National Honor Society Oboe Organ Percussion Photography Piano Religious Organizations Saxophone Service Student Government Student Newspaper Study Abroad Theatre / Drama Trombone Trumpet Tuba Viola Violin Yearbook Young Democrats Young Republicans Who's Who-College
NCAA Division II Athletics (use the control [Ctrl] key to select multiple options)	Baseball Basketball Cheerleading Cross Country Dance Team Football Golf Soccer Softball Swimming Tennis Track & Field Volleyball
Comments? Questions?