GNATURE I verify that the information given is true and accurate to the best of my knowledge. S - /4Q ( IIIIIII jEMO.FFIO.SgcPS)ta ., W ID) SCA W) 2331 OS STUDENT NO (55) COB US %) ENTRY CO. (57)EWIRY DATE E01 08/14/01 (MGR LY 08 (H)M. 01 (50) TEACHER NO (61)REASSION ONE OR TRANSA