| NAME |
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Last name: (Family Name/Surname)* |
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| First name: *
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| Middle name: |
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| Birth date :* |
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| Gender : |
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| MAILING ADDRESS |
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| Mailing
Address number and street: * |
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| Apt/Box
Number: |
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| City:
* |
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State/Province: *
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US/Canada
International
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| Zip/Postal Code: (Required for US and Canada) * |
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Country: *
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| CONTACT INFORMATION |
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| Home Telephone: (U.S. Only) |
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| Business Telephone: (U.S. Only) |
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-
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| E-mail
Address: * |
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| Confirm E-mail
Address: * |
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| RECENT SCHOOL ATTENDED |
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| Name of High School/College: |
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| CEEB Code:(US high school only) |
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| Click here if you don't know the code |
| Month and Year of Graduation: |
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| ADMISSION REQUIRED |
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| Admission
Type: * |
Freshman
Transfer
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Entering Semester: *
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Fall
Spring
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Entering Year:
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| ACADEMIC PROGRAMS |
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| Please indicate your choice of major: (Select only one.) |
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School of Architecture
College of Computing Sciences
College of Science and Liberal Arts
School of Management
Newark College of Engineering
Engineering Technology
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