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Date of Birth:	/ /
First Name
MI
Last Name
Maiden
E-Mail Address
Local Phone	- -
Phone	- -
Gender	Male Female
Marital Status	Single Married
U.S. Citizen?	Yes No
Ethnicity
When did you first enroll at OSU-Okmulgee?	/
How many hours are you taking?
How many credit hours have you earned?
What is your major?

What is the highest grade completed by the Parent(s) you grew up with?
Mother: Father:
If you/your family filed Income Taxes last year, what was your TAXABLE income?
Number of people living in your household
Single Parent?	Yes No
Have you applied for Financial Aid yet?	Yes No
Have you ever participated in a TRIO program before? (i.e. Upward Bound, Talent Search, SSS, EOC, etc.)
Do you need special accommodations?	Yes No
If so, what kind?
Do you have documentation?	Yes No
If so, what for?
High School Attended
City
State
Did you Graduate?	Yes No
Highest grade completed
GED?	Yes No
Year graduated
High school GPA
Date recieved GED:	/ /
What schools other than high school have you attended?
Year started
Year ended
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