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- Date of Birth*
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Format: (000) 000-0000.
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- Are you a current graduating high school senior?*
- Are you a United States citizen?*
- Do you have a cumulative GPA of at least 2.5 on a 4.0 scale?*
- Do you plan to enroll full-time at an accredited two or four-year college, university, or vocational school?*
- Is your annual household income $60,000 or less?*
- Are you a board member, an immediate family member of a board member (son, daughter, sister, brother, grandchild), or a legal or permanent household resident of a board member or covered affiliate?*
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- Expected Graduation Month/Year*
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- Acceptance Status*
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- Annual household income*
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- Is student employed*
- Does student contribute to household*
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- Date*
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- Should be Empty: