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UT southwestern Medical Center

UT SOUTHWESTERN MEDICAL CENTER

version:1.0 (last updated:05/12/2015)

	To sign up for an account please provide the following information
	* Required

* First Name
* Last Name
* Primary Email
* Retype Primary Email
Secondary Email
* Birth Date	/ / (month/day/year)
TMDSAS ID	(Required for Medical school applicants only)

* Secret Question 1:
* Secret Answer 1:
* Secret Question 2:
* Secret Answer 2: