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Cell P'Ilicne : <br />Home Phone (if different) <br />-. <br />or Phone (if different): <br />Home Fax: <br />Work Fax: <br />Home Email: <br />Work 8mail: <br />Student Application: No <br />If yes, please list your grade: <br />May we contact, you using your work email or fax Yes <br />I have read are understand the statements on thy' s forms and I hereby swear or affirm that <br />the t,at,lements on this form, are true. -. Yes <br />Additional Information: <br />I <br />Form submitted on: 6/24/20�08 9:39:31 PM <br />Submitted from IP Address: <br />Form Address: httpl-.//ww,w.ci.rosev'llle.mn.us/forms.asp?F'ID=237 <br />6 <br />