| *First Name: |
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| *Last Name: |
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| Phone Number: |
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| *Email Address |
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| *Mailing Address: |
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| *City: |
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| *State: |
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| *Zip: |
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Would you prefer information on Freshman, Transfer,
or Graduate level of study, or on certificate programs? |
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| Please describe for us what information you are requesting: |
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| What term and year do you plan to start at UCCS? |
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| Year: |
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Validation Code
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* denotes required field |
