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Evening Phone: <br />Cell Phone: <br />Home Phane {if different): <br />Work Phone {if different): <br />Home Fax: <br />Work Fax: <br />Home Email- <br />Wprk Email: <br />S�udent Application: No <br />Tf yes, please lis� your grade: <br />May we cantact you using your work email or fax?: Yes <br />I have read and understand the statements an this �orm, and I hereby swear or affirm tha� <br />the statements on this form are. true. : Yes <br />Addit�onal �nformation: <br />Farm submitted on: 2/27/20d9 11:03:33 ANI <br />Submitted from IP Address: <br />Form Address: http://www.ci.roseville.mn.us/forms.asp?FID=237 <br />2 <br />