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Name: _____________________________________________________________________________

Address: ____________________________________________________________________________

Telephone: __________________________________________________________________________

Email: ____________________________________________________________________________

What college/university do you plan to attend? ___________________________________________

If known, what is your anticipated college course of study? __________________________________

Weighted GPA: __________________________ Unweighted GPA: ___________________________

Please attach your essay and resume to this application.

Essay:

If you had an opportunity to make a difference in the world, what would it be and how would you
proceed? (250-500 words)

_____________________________________ ______________________

Signature Date

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