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First Name *

Last Name *

Home Address *

Home Phone

Cell Phone *

USC Lancaster Email *

[email protected]

Other Email

How did you learn of this organization? (Please check all that apply) *

ClassmateFacultyFamily/FriendLancaster NewspaperLancer NewsLearn TVStaffSocial Media

Do you promise to strive towards academic excellence; and to commit to participate in Omega Scholars monthly meetings and community service projects? *

YesNo

If not, please state why you cannot.