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NOVA Vision Conference 2021: Student Registration
Tuesday, April 20, 2021
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* Indicates required question
First Name/Nombre
*
Your answer
Middle Initial
Your answer
Last Name/Apellido
*
Your answer
Street Address
(Include apartment/unit numbers)
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Date of Birth
MM
/
DD
/
YYYY
Phone Number
Your answer
Email address (We will forward the meeting link to this email address) Dirección de correo electrónico (reenviaremos el enlace de la reunion a esta dirección de correo electrónico)
*
Your answer
Please list the name of your high school/program:
Your answer
Anticipated year of high school graduation:
Your answer
When do you want to start classes at NOVA?
Summer 2021
Fall 2021
Spring 2022
Summer 2022
Fall 2022
Other:
Clear selection
What do you want to study at NOVA?
Option 1
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Please list any additional info you would like NOVA to send to you:
Your answer
If you require language interpretation and/or ADA accommodations to participate, please indicate your needs below. Si Necesita interpretación y/o adaptaciones de la ADA para participar, indique sus necesidades.
Your answer
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