Personal Information
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Family Name*
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Given Name(s)*
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Gender*
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Address*
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City*
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State/Province
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Country of Residence*
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Postal Code
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Telephone
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Date of Birth(MM-DD-YYYY)*
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E-mail Address*
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Citizenship*
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Academic Information
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School/University
Currently Attending/Last Attended*
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Year You Want to
Begin Your Studies in the
United
States
*
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Current TOEFL Score
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Degree Desired*
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Preferred Area of
Study*
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If Other, Please
Specify
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Amount of Money Available
Per Year to Pay for Study (in U.S. Dollars)*
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Academic Ability
When Compared with Your Peers
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Marketing Information
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How Did You Learn
About the
Actovian
?*
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If Newspaper or Other,
Please Specify:
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Invite your friends to the fair (optional)
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