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Gerber Grand Challenge Interest Form
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Slate ID (matching, hidden)
Full first name
Preferred first name (if different from your full first name)
Legal last name (please do not include any former last names)
Birthdate (for matching to your Augustana record)
Birthdate (for matching to your Augustana record)
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Full first name
Preferred first name (if different from your full first name)
Legal last name (please do not include any former last names)
Birthdate (for matching to your Augustana record)
Birthdate (for matching to your Augustana record)
January
February
March
April
May
June
July
August
September
October
November
December
1
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Email address
Please select one of the following options:
I am interested in establishing a new scholarship
I am interested in giving to an existing scholarship
I am interested in giving a gift to generally benefit the Gerber Grand Challenge
Other
Please share more about your interest in the Gerber Grand Challenge:
How do you prefer we contact you?
Email
Phone
Either
What is your preferred email or phone number?
Is there anything else you would like to share at this time?
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