male female

first name
last name

email
email good until (date)

name of school
IV chapter (if more than one at your school)
year you plan to graduate

College address (if different from permanent address)
street 1
street 2
city/state/zip
phone
address good until (date)

Permanent address:
street 1
street 2
city/state/zip
phone

person to notify in case of emergency
phone

Send my advance assignment and general info to me by:
E-mail to the above address
surface mail to my school address
surface mail to my home address

I would characterize myself as an introvert extravert.

Race: Asian Black Hispanic/Latino other White

Financial package: $998 special full price$898 subsidy price

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