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3820 J. Bennett Johnston Avenue Lake Charles, LA 70615 Phone: (337) 491-2608 Fax: (377) 491-2135
Name & school: Address: City/st/zip: Phone: Curriculum: Birthday: School eMail: Month Pager/cell: Estimated Graduation: (semester year) Day
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Please write the office you are interested in with a paragraph stating your qualifications. Turn in this form with a resume and letter of recommendation.