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Full Name (first, middle, last)
Full Name in Kanji (if applicable)
Address
City
State
Zip
Email
Telephone
Cell
Place of Birth
Birthday
Father's Name
Father's Occupation
Mother's Name
Mother's Occupation
JAA Member? (if no, please contact JAA office)
Yes
No
Name of Member
High School
Name
High School Address
Scholastic Honors Received
High School Extracurricular Activities
Other Activities (e.g. community service, volunteer work, clubs, jobs, etc)
Intended US College/University (application accepted or pending)
Please describe any special financial circumstances you'd like us to consider:
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