Graduating Recipients Form
Name

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Are you currently graduating from a UC or are you three years post-graduation?



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How has the Peggy and Jack Baskin Foundation impacted your life? (*)

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If applicable, what is your current career?

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What are your future career plans? (*)

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Additional Comments

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What is the best way to contact you in the future? (*)

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Address

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City, State, Zip

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Email

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Fax Number

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