Student Name: 

Student Tiger I.D. Number: 

Preferred Email Address: 

Permanent Address:
(include street address, city, state & zip code)
 

Academic Major: 

What do you hope to gain by being a member of the C.U. on Campus learning community?

Why do you want to be apart of the C.U. on Campus learning community?

I agree to be an active participant in the C.U. on Campus learning community.

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