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Hame Fax: <br />Work Fax: <br />Home EmaiT: <br />Work Ernail: <br />Student Application: No <br />If yes, please list your grade: <br />May we. contact you using your work email qr fax?; Yes <br />I have read and understa�d th� statemEnts on this form, and I hereby swear or affirm that <br />the statements on this form are true. : Yes <br />Additional InformaCion: <br />F'orm submitted on:. 2/21/2009 3:04:50 PM <br />Submitted from IP Address: <br />Form Address: http://www.c'��ofroseville.com/farms.asp2FI�-237 <br />2 <br />