Umoja Information Form

First Name:
Last Name:
Student ID Number:
Email Address:	Enter a valid email address. Example: jdoe@domainname.com
Home Phone (include area code):
Cell Phone (include area code):
Street Address:
City:
State:
Zip Code:
Major:
Transfer/Graduation Date:
Transfer Institution:
How many semesters have you completed at Citrus?
I am interested in receiving information about Citrus College's Umoja Program.
I am interested in joining Citrus College's Umoja Program.
I am interested in being informed of upcoming Umoja events and activities at Citrus College.
Other:

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