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Local Address: City: Local Phone: State: Zip Code: Cell Phone: Major: E-Mail: Best way for your Mentor to contact you? Hobbies or special interests: Please circle your answer: First time in the Faculty Mentor Program? YES Gender: Male Female Ethnicity: African American/Black Caucasian/White Hispanic NO Asian American/Pacific Islander Native American Other/Undeclared How did you hear about FM.

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