[fill in after : ] Name: Social Security #: Address: Tel. #: City: State: Zip: Date of Birth: Date of HS Grad: E-mail Address: Guardian or Parents' Name(s): High School: HS Coach: Coach's Phone Number: Guidance Counselor: Counselor Phone Number: USS Team: USS Coach: Coach's Phone Number: Class Rank: Class Size: GPA: SAT I Test Scores: Verbal: Math: ACT: SAT II Test Scores: English: Math 1 or 2: Other: Major Academic Interests: Applying to: Columbia College: Engineering: Do you intend to apply for Finacial Aid?: Are you interested in early decision?: Best Events & Times:

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