v.....        .  3
Last Name of  dent (Please Print)  First N  e  Middle Initial
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Madison Address
A  r-oved                                J4

Telephone Number

I

ema. Second Sem.

M    )ajor Pr  f sor

SUBJECT     Subject   HOUR AND DAYS     INSTRUCTOR
(Name of Department)  No.  Credits  (e. g., 7 45 MWF)  (one in charge of subject)
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S2pQ__          /7