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Thank you for taking the time to fill out this form. If you are unsure about an answer or the question does not apply to you, please leave that field blank. You can also print out this form and fax it to (570) 450-3145 or mail it to Dr. Thomas Caccese, Director of Athletics, 76 University Drive, Hazleton, PA 18202. If you need more spaces for additional information, please use the comments section at the end of this form.

All requests are reviewed by the Director of Athletics, someone from the department will contact you within a week of your submission.

 

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