Which course are you registering for	Gainey-Martin Project Cooper-Jones Initiative Other
Date this application is being filed (e.g., January 1, 1998)
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Full name of person submitting this Registration (e.g John A. Smith)
Registrant's First Name:
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Middle Initial:
Email Address:
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State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delawa re Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan<Opti on Value=Minnesota>Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
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Gender:	Male Female
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What school, institution, or organization are you taking this course through
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