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- .` . � <br />P <br />The following information is requested to process your application. � <br />� <br />� <br />� <br />Name: � <br />Address: u� <br />CitylSta�el�ip: <br />Roseville Resident: <br />Hame Telephone: <br />�ome Fax: <br />Years I <br />� <br />Work Telephone: .. _ <br />Work Fax: <br />Home Emai1: <br />Warlc Email: _.,,,, _. � <br />Student Applicant: o Yes, Grade <br />o No <br />May we contact you using your worlc e�nail or fax: Yes <br />No <br />� <br />� <br />