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First Name: Middle Initial:
Last Name:
Address:
City:
State: Zip:
Phone:
Email:

I am interested in attending Evergreen:
Quarter: Year:

My primary area of academic interest is:

I am interested in the following intercollegiate sport(s):
Men's Soccer Women's Soccer
Men's Basketball Women's Basketball
Men's Cross Country Women's Cross Country
Track and Field Women's Volleyball

School Information:
Last school attended or school currently enrolled in (College/University if transfer):
State in which the school is situated:
Year in school:
what sports did you participate in which in high school or college?

OPTIONAL -- My ethnic background is:
Asian Pacific Islander Other:
African American Hispanic
Caucasian American Indian
Comments or requests:

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