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Information Request Form

Information Request Form

The following information is available online for you to view or download. In addition, you may request that we mail you a copy of the information by filling in the following request form.

*Required fields

* Legal Name (Last Name, First Name, MI):
Preferred Name (Last Name, First Name, MI):
* Street Address:
* Zip Code:
Daytime Phone Number:
*E-mail Address:
*Date of Birth (MM/DD/YYYY):
Gender: Male Female
Ethnic Information:
Semester to Begin at IU Kokomo:

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