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Student's First Name
Student's Last Name:
Phone:
Email :
Address:
City:
State:
Zip:
Choose a CPOAPA Rep
Name of High School:
Graduation Date:
Overall GPA:
Core GPA:
SAT Score:	Verbal:	Math:
ACT Score
Your Sport(s):
Athletic Awards:
Academic Awards:
Coach's Name:
Coach's Tel (work):
Coach's Tel (home):
Other Teams:
Parent's Name:
Best Time to Call:
Other Comments:

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