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Personal/Contact Information

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Address:

Address:

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Email:

Date of Birth:

Age:

Education Information:

Highest level of education completed:

Current school:

Major(s) – if applicable:

Expected graduation date:

Current grade point average:

 Do you have an interest in Science, Technology, Engineering, and Mathematics (STEM) as a future career?

YES:

NO:

Additional Information:

Goals:

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Contact Information

P.O. Box 194

San Clemente, CA 92674

949.734.5656

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