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Welcome to URSA

Application for acceptance

Your name: ______________________
Father's maiden name: ______________________
DOB: (If known) ______________________
Place of birth: Hospital  Farm Trailer / Mobile home
Members in household: Five or more Ten or more More than 15
Have you ever attended high school? Yes No I don't know
(If yes, please explain)

Please print and mail this to:

Attn: URSA
P.O. Box 00000
S.E. AL, 35550

 

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