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Work Fax: <br />Home Email: <br />Work Email: <br />Student Application: No <br />If yes, please list your grade: <br />�ay we cantact you using yaur work email or fax?: Yes <br />I have read and understand the statements on this form, and � hereby swear or affirm that <br />the sta�emen�s an this form are true. : Yes <br />Additional Tnformatiion: <br />�orm submitted on: 2/25/2009 7:07:55 PM <br />Submitted from IP Address: <br />Form Address: http://w+rrW.ci.roseville.mn,us/forms.asp?FID=237 <br />2 <br />