| CONTACT
INFORMATION |
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Contact
Name:
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| Address: |
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| City/Province/Region: |
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| State
(USA Only): |
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| Zip
or Postal Code: |
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| Country: |
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| Telephone: |
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| Email
Address: |
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Social
Security Number:
(Optional - xxx-xx-xxxx) |
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| SCHOOL
INFORMATION |
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| High School
Attended : |
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| City
of High School: |
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| State
of High School: |
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| JAG
Specialist in High School: |
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| #
of Years in JAG Program: |
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| Year
Graduated: |
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| MILITARY
INFORMATION |
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| Service
Status: |
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| Branch of
Military : |
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| Current
Rank: |
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| Base
of Operations : |
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| Military
Address: |
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| Military
City/Province/Region: |
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| Military
State (USA Only): |
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| Military
Zip or Postal Code: |
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Military
Country:
(mailing address) |
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| Military
Telephone: |
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| Military
Email: |
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| EMPLOYMENT
INFORMATION |
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| Employment
Status: |
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| Name
Where Employed: |
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| Work
Address: |
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| Employer
City/Province/Region: |
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| Employer
State (USA Only): |
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| Employer
Zip or Postal Code: |
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| Employer
Country: |
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| Work
Telephone: |
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| Work
Email: |
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| Job
Title: |
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| Job
Category: |
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| POSTSECONDARY
EDUCATION INFORMATION |
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| Type of
Institution: |
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| Name
of Institution: |
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| Major
Area of Study: |
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| Projected
Graduation Year: |
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| GENERAL
INFORMATION |
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| Marital
Status: |
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| Dependent
Children : |
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| Annual Estimated
Income: |
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| #1 Benefit
You Received from Being a JAG Participant: |
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| Best Recommendation
to Improve the Program for Others: |
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| Any Other
Comments You Would Like to Share with JAG: |
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Would
You Like to be Placed on a Mailing List for:
Check all that apply. |
JAG Annual Report |
National JAG Events in District of Columbia |
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State JAG Events (where you reside) |
Other JAG Mailings - (research reports, Crossroads
newsletter, etc.) |
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