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General Undergrad
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First Name
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Last Name
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Student Phone
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Student Email
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Program of Study*
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Program of Study*
Art
Biology
Business
Chemistry
Education
English
General Studies
Humanities
Kinesiology & Exercise Science
Legal Studies
Mathematics
Medical Laboratory Science
Nursing
Practical Nursing - Certificate
Pre-Health
Psychology
Rehab Science
Undecided
Anticipated Start Date
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Anticipated Start Date*
Fall 2026
Fall 2027
Fall 2028