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2. First Name*
3. Last Name*
5. Address: Street*
7. City*
8. Zip Code*
10. Are you a resident of Vernon Township*

    1. Yes
    2. No
12. Email Address*
13. Phone Number*
15. Parent(s) or Legal Guardian(s) Names*
17. Current High School *
18. Graduation Year*
20. I plan to attend the following College or University*

    *Proof of acceptance or enrollment from the above school will be required to funds being released

22. I plan to attend in the Fall of 2023 or the Spring of 2024*

    1. Fall 2023
    2. Spring 2024
24. Current Grade Point Average and on what scale*
26. Please upload your most recent official school transcript*
28. Specialty/Major you intend to study*
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field