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First Name
*
Last Name
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College Attending
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Student Phone
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Student Email
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Address
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City
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State
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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
Zip
*
Program of Study
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Program of Study*
Applied Psychology & Human Services
Art
Biology
BOLD Studies for Deciding Students
Business
Chemistry
Early Childhood Education
Elementary Education
Elementary Education & Special Education
Middle School Education
K-12 Education
Secondary Education Endorsement
English
General Studies
Human Biology
Humanities
Kinesiology & Exercise Science
Legal Studies
Mathematics
Medical Laboratory Sciences
Nursing
Occupational Therapy
Pre-Health
Pre-Physician Assistant Studies
Physical Therapy
Psychology
Theology
Anticipated Start Date
*
Anticipated Start Date*
Fall 2024
Spring 2025
Fall 2025
Spring 2026