Application Form

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Student Information

First Name

Last Name

Sex

Male

Female

Age

Date of Birth

Place of Birth

Citizenship

Student's Social Security #

Height

Weight

Hair Color

Eye Color

Students Current Residence Address

Address 1

Address 2

City

State/Province

Zip/Postal

SRS Education

SRS participates in NSLP. Therefore in accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution does not discriminate on the basis of race, color, national origin, sex, religious creed, disability, age, political beliefs, or reprisal or retaliation for prior civil rights activity.

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