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STARTALK 2019 Summer Language Program at Hunter College Application Form
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Chinese Name
(If applicable)
Your answer
Do you have a social security number
*
Yes
No
Date of Birth (Month/Date/Year)
*
Your answer
Sex
*
Male
Female
Required
Permanent Address
*
(Please include city, state, and zip code)
Your answer
Telephone Number (Day)
*
Your answer
Telephone Number (Eve)
*
Your answer
Email Address
*
Your answer
Name of Your School
*
Your answer
Grade Level
*
(Spring 2019)
Your answer
GPA
*
Your answer
SAT/PSAT score
(If applicable)
Your answer
U.S. Citizen?
*
Yes
No
NY State Resident
*
Yes
No
Parent/Guardian Name (A)
*
Your answer
Relation to Applicant
*
Your answer
Telephone Number
*
Your answer
Email Address
Your answer
Parent/Guardian Name (B)
Your answer
Relation to Applicant
Your answer
Telephone Number
Your answer
Email Address
Your answer
Person to Contact in Case of Emergency (A)
*
(Other than parents)
Your answer
Relation to the Applicant
*
Your answer
Telephone Number
*
Your answer
Person to Contact in Case of Emergency (B)
*
(Other than parents)
Your answer
Relation to the Applicant
*
Your answer
Telephone Number
*
Your answer
Applicant Signature
*
(Please type name)
Your answer
Date
*
Your answer
Parent/Guardian Signature
*
(Please type name)
Your answer
Date
*
Your answer
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