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ME STUDENT ID# LAST FIRST ADDRESS MARRIED/SINGLE GENDER CITY BIRTHDATE MAJOR/S: INSTITUTION: GRADE COURSE COURSE TITLE STATE ZIP CODE ETHNIC OPTION VALUE V MEETING TIME DATE CHAIRPERSON OR PROGRAM DIRECTOR SIGNATURE DATE ROOM INSTRUCTOR GRADE OPTION: V - AUDIT REGISTRAR OFFICE USE ONLY DATE INSTRUCTOR SIGNATURE ETHNIC CODES 0.0 Registration in an undergraduate course as a Senior Citizen audit will require the instructor and the departmental chairperson or program.

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