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(other) E-mail (home) E-mail (work) E-mail (other) FAX ZIP The information requested below is optional and is used for institutional statistical research only. This information is not a criterion for acceptance. Birth date q Male q Female Social security number Marital status q Single q Widowed q Divorced q Married (spouse s name) Citizenship: q U.S. citizen q Other Resident status if non-U.S. citizen: Racial/Ethnic group: q American Indian, Alaskan Native q Asian-American/Orie.

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