School of Medicine and Health Sciences |
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APPLICATION FOR A CULTURAL DIVERSITY TUITION WAIVER |
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| Last Name | |
| First Name | |
| Address | |
| City | |
| State | |
| Zip | |
| Social Security Number | |
| Phone Number | |
| Please Check all that Apply: | |
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______Culturally Diverse ______Enrolled Member of a Federally Recognized Indian Tribe ______Economically Disadvantaged ______American Indian with Documented Lineal Heritage |
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Please indicate below why you should be considered for this waiver.