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If you are a high school faculty or staff member, please complete the information below to begin your enrollment as a High School Registrar.  Thank you for your concern for the students enrolled at your school.
  
   Male      Female 
  First Name
  
MI

Last Name
  Title
  

   School Name
  
   Address
  
   City
  
State

Zip Code

   Phone
  
Fax
Email

   Private School     Public School   
   If you are a male, did you register with Selective Service?   Yes       No       Was Not Required to Register
   Are you a U.S. citizen?    Yes       No

   Comments:
 

                                               


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Revised June 9, 2009