basic scholarship & grant application - the ciri...

CITC Scholarship Application Tribal Higher Education (THE) Scholarship

Administered by The CIRI Foundation

Applications must be submitted by 11:59 p.m. Alaska Time on the day of the deadline. Applications will be considered in the order they were received – first completed, first awarded.

Submit your application and documents to TCF via mail, email, fax, or hand-deliver at: The CIRI Foundation | 3600 San Jeronimo Drive, Suite 256, Anchorage, AK 99508 | Phone: (907) 793-3575 Toll-free: 1 (800) 764-3382 | Fax: (907) 793-3585 | [email protected] - 1 -

A. PERSONAL DATA

1 Name (Last, First, M.I.)

, , Other Last Names Used (if applicable)

2 Mailing Address (correspondence will be mailed here) E-mail Address (correspondence will be emailed here)

3 City State Zip Code

Tel No.

4 Date of Birth (mm/dd/yyyy) Sex

Male FemaleVeteran?

No Yes

5 Are you related to a current Board member of The CIRI Foundation? (not Cook Inlet Region, Inc.)

No Yes If yes, provide their name and your relationship.

B. ELIGIBILITY

C. EDUCATION LEVEL & EDUCATION HISTORY

13 I am currently in college: Freshman (0-29 cr.) Sophomore (30-59 cr.) Junior (60-94 cr.)

Senior (95+ cr.) Graduate Degree PhD

14

Check ALL that apply -AND- enter date of completion

I am currently in High School Date: / /

I am a High School Graduate Date: / /

I have a General Education Diploma (GED) Date: / /

I have a vocational training/certificate Date: / /

I have a 2-year Associates Degree Date: / /

I have a 4-year Degree Date: / /

I have a Master’s Degree or PhD Date: / /

I have not been enrolled in the past five years – still required to submit most recent transcripts

6 My ANCSA Regional Corporation is: (Check all that apply)

Ahtna Aleut ASRC BSNC BBNC Calista Chugach CIRI Doyon Koniag NANA Sealaska Other

7 I certify that I am an Alaska Native (Check only one) CIRI Shareholder -or- Direct Lineal Descendant

8 I am a direct lineal descendant of CIRI Shareholder: (Last, First, M.I.)

, , Relationship to shareholder:

9

I am a Tribal member of the following Cook Inlet Region village: Chickaloon Village Traditional Council Native Village of Tyonek (not Tebughna Foundation funding) Kenaitze Indian Tribe Knik Tribal Council Ninilchik Traditional Council Salamatof Tribal Council None

10 I am applying for the following CITC Scholarship Deadline: December 1, 2017

11 Have you applied to CITC before? No Yes If yes, when?

12 I am enrolled in an Alyeska Match qualifying program (programs noted on page 7) and I would like to be considered for Alyeska Match Funding No Yes

(If self, enter self)

Available November 1- December 1, 2017

mailto:[email protected]





D. EDUCATION PLANS

15Name of School

16 Financial Aid Office Address - If awarded, this is where the check is mailed to Telephone No.

17 City State Zip Code Fax No.

18 Current Degree Program: 2-year Associates 4-year Bachelors Masters Doctorate

19 I am applying for the Spring:

Winter/Spring: Term Start Date: Term End Date: *Note: You cannot apply for courses completed prior to the applicationdeadline.

20 My school calendar is based on: Semesters Trimesters Quarters Other:

21 I will be enrolled: Full-time -or- Part-time during the term listed above.

22 I will be taking (#) credits for the term dates listed above. ***Please immediately send TCF written notification of any schedule or enrollment changes.***

23 Check this box if your program is online, distance-delivery, or correspondence.

24 Declared Major: If declared, what is your field of study? Declared Minor: If you have declared a minor, what is your field of study? Undeclared

25 Expected Graduation Date (mm/dd/yyyy): / /

26 My most recent cumulative grade point average (GPA) is: (If most current education is GED, put 2.5 for GPA)

27 I understand that I am expected to complete all of the courses and credits for which I receive funding from CITC (check box).

E. BUDGET FORECAST

Complete your education budget for the term specified on line #19. Do not leave any blanks. If the amount is zero, put -0-.

A. EXPENSES AMOUNT B. SOURCES OF FUNDS AMOUNT Direct Academic Costs Tuition $ Personal/family contribution to education $

28 Student fees $ Tuition waiver $ Books & required supplies $ Veterans Administration Aid $ Room and Meal Plan Costs (♣) State/Federal Social Security $ On-campus housing $ State/Federal Student Loans / Grants $ On-campus meal plan $ Other Scholarships / Grants $

Other Tribal Scholarships / Grants $ Other (specify): $

TOTAL EXPENSES $ TOTAL SOURCES OF FUNDS $ AMOUNT NEEDED=(TOTAL EXPENSES - TOTAL FUNDS) $

29 While attending school, will you be living in on-campus housing provided by your school?

Yes No ♣ Only students living in school-provided, on-campus housing are eligible to use award funds toward housing and/or meal plan costs






.

30 I am receiving/have applied for other scholarships or grants: No Yes

If yes, list all other funding sources from which you have applied for funding for this term; you may note if tentative. Please note any funding awarded/applied for from other Alyeska Sources (i.e. Internships, scholarships, etc.). See Page 11-12 for full list of Alyeska partner organizations. You may only receive up to $7,500 in Alyeska Match funding from any/all sources.

F. CERTIFICATION (READ CAREFULLY)

31

By signing this statement, I acknowledge that I have read and agree to the funding guidelines and terms specified below:

1. To the best of my knowledge, the information in this application is true, correct, and complete.

2. It is my responsibility - not that of The CIRI Foundation (board or staff) or any other party (e.g. parent, spouse, academic advisor) – to obtain and submit all the necessary application materials on or before the deadline to receive consideration for any award.

3. I give The CIRI Foundation permission to access my previous scholarship and grant

applications, and supporting documents on file with Cook Inlet Tribal Council, for the purpose of processing current and future applications with The CIRI Foundation.

4. This application does not obligate The CIRI Foundation to award an education scholarship or to pay any costs incurred in the submission of this application. All decisions made by TCF are final.

5. If approved for a scholarship or grant, I agree to abide by the terms and conditions of the award. If, for any reason, I am unable to use the award for which I am selected, the full amount or any portion thereof is to be refunded to The CIRI Foundation.

6. I understand that I am required to complete all courses and credits for which I am funded.

7. All applicant information is kept confidential in accordance with the Family Education Rights and Privacy Act of 1974. Information will not be released to another party, including parents or family members, without having written consent of the applicant.

8. I give The CIRI Foundation permission to release, as appropriate, my comments, photo, name, address,

email, and telephone number for employment or education referrals and CIRI, CITC or related publications.

SIGNATURE: ___________________________________ DATE: ________________


CITC Scholarship Application Tribal Higher Education (THE)




CITC Scholarship Document Checklist Tribal Higher Education (THE)

Use this checklist to make sure that you have all your documents ready.

Applications must be submitted by 11:59 p.m. Alaska Time on the day of the deadline.

TCF does not accept late applications.

Supporting documents may be submitted after the application deadline, but completed and signed applications must be received by TCF on time.

CITC THE Application

Completed and signed CITC Higher Education application (pages 1-3)

Supporting Documents:

CIRI documentation (voting CIRI shareholder or direct lineal descendent documentation)

Cook Inlet Region affiliated tribe’s relevant award letter and/or denial letter for tribal funding

(Tribal members must seek funding from their local tribe first)

Certificate Degree of Indian Blood (CIB/CDIB)

Proof of Selective Service Registration (applies toward males ages 18-25)

Statement of purpose (300 words minimum)

Reference letter (from a non-family member)

Official transcripts noting cumulative GPA of 2.0 or higher

Acceptance letter or academic program change (must include degree program and major)

Updated class schedule with credit load

Tuition Statement/ Education Cost Statement






CITC Scholarship Document Descriptions Tribal Higher Education Scholarship (THE)

• CIRI Documentation — CIRI shareholders do not need to provide any further

documentation; TCF can verify your shareholder status. Direct lineal descendants of CIRI shareholders must provide documentation that shows you are a lineal descendant of a CIRI shareholder. Documents may be available from CIRI Shareholder Relations: (907) 263-5100, toll free (800) 764-2474, or via email at [email protected]. Only first time applicants need to submit.

Options: A CIRI lineal descendant registration card (plan ahead for processing time) Birth certificates and any name change documents that link you to a CIRI

shareholder A letter from CIRI Shareholder Relations that states you are a lineal

descendent of a CIRI shareholder

• Cook Inlet Region tribe award/denial letter for tribal funding — Applicants who are enrolled in a Cook Inlet Region tribe (Chickaloon, Kenaitze, Knik, Ninilchik, Salamatof, or Tyonek) must apply for the tribe’s scholarship program first. You will only be eligible for the CITC Scholarship if you are denied by the tribe you are enrolled in. You need to provide verification of the denial of the scholarship funding from your tribe in order to be eligible for CITC funding.

• Other funding sources – Applicants must provide notice of all other scholarships received and applied for during this application period. This can be done on line 30 (on page 3) of the application.

• Proof of Alaska Native/American Indian (AN/AI) Blood — This is your Certificate

Degree of Indian Blood (CDIB or CIB). This is available from the Bureau of Indian Affairs (BIA) office at http://www.bia.gov/WhoWeAre/RegionalOffices/Alaska/. Only first time applicants need to submit.

• Proof of Selective Service Registration — This is required for male applicants between the ages of 18-25. Available here: https://www.sss.gov/regver/wfverification.aspx

• Statement of Purpose — This is a 300-word short essay (like a letter to TCF) identifying your professional goals.

• Most current Official Transcripts noting cumulative GPA (you must have and maintain a minimum cumulative GPA of 2.0 to be eligible for the Tribal Higher Education Scholarship) — Available from your school’s Office of the Registrar. TCF will accept your unofficial transcripts in-person only if it is printed, witnessed, and signed by a TCF staff member. If college transcripts are not yet applicable, high school transcripts or GED documentation are required.



http://www.bia.gov/WhoWeAre/RegionalOffices/Alaska/

https://www.sss.gov/regver/wfverification.aspx





• Acceptance letter noting degree and major or academic program — This is a letter from your school granting you admission and stating your declared major or program change documentation. This information may also be on your transcripts or printed from student portal.

• Current class schedule with credit load — Available from your school’s Office of the Registrar or via your online student portal. Undergraduate students must show enrollment in (12+) credits to be considered full-time, or include an official document from the school verifying the credit load considered full-time at the institution. Full-time graduate students must show enrollment in (9+) credits, or include an official document from school, verifying the credit load considered full-time at the institution. Part-time students will be awarded funding based on pro-rated calculation of their enrolled credits. Students MUST complete all courses outlined.

• Tuition Statement/ Education Cost Statement — Available from your school via your online student portal or your school’s financial aid office. This may also be called Financial Term Details, Semester Budget, Financial Need Sheet, Cost Information Sheet, or Statement of Student Account. At a minimum, your tuition statement must show the actual cost of your academic program for the term (tuition, fees, required books, on-campus room and board); this may not be an estimate.

• Reference letter from a non-family member — Letter recommending you as a good

candidate for college, with the skills and desire to complete your degree program and college goals. Letter must contain date, signature, and contact information from referrer. This can be from a teacher, counselor, supervisor or any non-relative who can speak to your academic potential. For your reference, see the sample letter below.

Sample letter of recommendation

MM/DD/YYYY To Whom It May Concern: I have known Your Name for the past two and a half years, having served as her teacher in both English and Arts at ________ High School. I believe that Your Name is very well suited for higher education. Your Name is a bright and attentive young person. In class and in her work, she demonstrates that she is an intelligent and capable student with great potential. I am confident that she will thrive in any academic program that she chooses to pursue. I am convinced that Your Name would make a more than valuable contribution to your university. She has my highest recommendation. Should you have any questions, please do not hesitate to contact me. Sincerely, Name of Non-Relative Teacher, _______ High School Contact Information


Alyeska Pipeline Service Company Alaska Native Program Scholarship Awards

Fall 2017/Spring 2018 Academic Terms


Submit your application and documents to TCF via mail, email, fax, or hand-deliver at: The CIRI Foundation | 3600 San Jeronimo Drive, Suite 256, Anchorage, AK 99508 | Phone: (907) 793-3575 Toll-free: 1 (800) 764-3382 | Fax: (907) 793-3585 | [email protected] -7-

Alyeska Match Scholarship

*Qualifying Programs for Fall 2017/Spring 2018:

• Accounting, Business Administration, Economics, Finance

• Construction & Project Management, Project Controls

• Culinary Arts, Oilfield Support

• Engineering, Computer Science /MIS

• Health Safety & Environment

• Instrumentation, Process Technology/SCADA (Supervisory Control And Data Acquisition)

• Maritime, Security

Alyeska Match Scholarship Checklist Completed CITC Tribal Higher Education application, including all supporting CITC application

documents- note that “Yes” must be checked in line 12 of the CITC Tribal Higher Education

Application in order to be considered for an Alyeska Match.

In addition, the following will be required:

Proof of enrollment in an approved Alyeska Match Qualifying Program

Alyeska Match Student Information Release & Attestation form

Applicant Equal Employment Opportunity (EEO) form

Current Student Resume

Most Current Official Transcripts noting cumulative GPA of 2.5 or higher

Other funding sources listed on line 30 of the application (report other scholarships or funding

from any other Alyeska sources (i.e. Internships, scholarships).

If you are enrolled in one of the qualifying programs* listed below and have at least a 2.5 cumulative GPA, you may apply for the Alyeska Match

Scholarship in addition to the CITC Scholarship.



Fall 2017/Spring 2018 Academic Terms


Submit your application and documents to TCF via mail, email, fax, or hand-deliver at: The CIRI Foundation | 3600 San Jeronimo Drive, Suite 256, Anchorage, AK 99508 | Phone: (907) 793-3575 Toll-free: 1 (800) 764-3382 | Fax: (907) 793-3585 | [email protected] -8-

Alyeska Match Document Descriptions Alyeska Match Scholarship (AM)

• Alyeska Student Information Release & Attestation (page 9 in this packet)

• Alyeska Applicant Equal Employment (EEO) form (page 10 in this packet)

• Current Student Resume — This is a document briefly outlining work and academic

skills and up-to-date experiences. It should contain all relevant schooling and employment information, and up to three references.

• Most Current Official Transcripts* noting cumulative GPA (you must have and maintain a minimum cumulative GPA of 2.5 to be eligible for the Alyeska Match Scholarship) — Available from your school’s Office of the Registrar. TCF will accept your unofficial transcripts in-person only if it is printed, witnessed, and signed by a TCF staff member. If college transcripts are not yet applicable, high school transcripts or GED documentation are required.

• Proof of Enrollment in an Approved Alyeska Match Qualifying Program* — This is a letter from your school granting you admission and stating your declared major or program change documentation. This information may also be on your transcripts or printed from student portal.

• Other funding sources — need to provide notice of other scholarships or funding (not

CITC), or from any other Alyeska sources (i.e. Internships, scholarships). This can be done on line 30 (on page 3) of the CITC application, or an additional page may be attached.

* - Document may also be used for your CITC Scholarship Application; two copies are not necessary.



Fall 2017/Spring 2018 Academic Year



STUDENT INFORMATION RELEASE AND ATTESTATION FORM

Dear Student,

Alyeska Pipeline Service Company’s (APSC) Alaska Native Program has provided scholarship and/or internship funding to the following Awarded Organization: ______Cook Inlet Tribal Council__________________. This organization has been selected to distribute funding for training and educational opportunities strategically focused in Trans Alaska Pipeline System and oil industry professions. Through this Awarded Organization, it has been determined that you are eligible to receive APSC funding.

The Awarded Organization will administer the program funding and monitor your progress during the period in which the scholarship or internship funds are received. This release form will enable the Awarded Organization to provide information to APSC regarding your progress or other information as requested, such as a current resume with contact information that may be used for purposes of employment or other recruitment efforts.

A condition of receipt of APSC funding requires that you complete this Student Information Release and Attestation Form and submit it along with a current resume, and any other requested documentation, to the Awarded Organization named above.

STUDENT ATTESTATION

I, Student Name: __ _________________________________________ consent that the Awarded Organization named above may release information to APSC regarding my progress as a student, now and beyond the period of my scholarship award. This information may include, but is not limited to: official grade transcripts, degree/certification program curriculum and completion dates, personal statements of career goals, and resume.

I understand that if my cumulative GPA falls below 2.5, I will no longer be eligible for APSC program funding.

I understand that I can only receive a maximum of $7,500 of APSC program funding per academic year, which may include scholarship or internship funding received from multiple organizations distributing APSC funds, including the Awarded Organization named above.

I understand that release of this information and attestation is a condition for receipt of scholarship or internship funds. I acknowledge that failure to abide by these requirements will jeopardize potential future APSC funding.

________________________________ ________________________________ Student Signature Date of Signature

________________________________ ________________________________ Printed Name Alaska Native Corporation/Village Affiliation

_______________________________ ________________________________ School Name Primary Phone

________________________________ ________________________________ School Address Alternate Phone

________________________________ ________________________________ Home Address Email Address

________________________________ ________________________________ Degree Program Estimated Graduation Date



Fall 2017/Spring 2018 Academic Year



Equal Employment Opportunity (EEO) Disclosure Form An Equal Opportunity Employer

7083 Rev. 12 (2/24/2015)

Equal Employment Opportunity Information Name: Last First

Alyeska Pipeline Service Company has an Equal Employment Opportunity/Affirmative Action Program. You may volunteer to help Alyeska in its efforts to comply with the program’s reporting requirements by answering the following questions. The information you provide cannot be used to discriminate against you under State or Federal law.

Gender: Female Male Birth Place: United States Other ____________

Ethnic Background (check all that apply)

White American Indian/Alaska Native* Native Hawaiian/other Pacific Islander

Black or African American Not Applicable (Non- U.S.) Other (please list all):___________________

Hispanic or Latino Asian ______________________________________

*(If you are Alaska Native please complete section below)

Alaska Natives Only

Certificate of Indian Blood (CIB) card? Yes No CIB Number:

Are you a shareholder of a Native Corporation? Yes No If yes, which Corporation?

Do you have a Certificate of Enrollment to your Native Corporation? Yes No

If you are not a shareholder, are your parents or grandparents shareholders of a Native Corporation? Yes No

If yes, which Corporation?

Are you enrolled with a Tribal Council? Yes No Please indicate name of Tribal Council:

Please use the space below to provide any additional information to help determine your EEO status.

7083 Rev. 12 (2/24/2015


Alaska Native Scholarship Program - Fall 2017/Spring 2018

Alyeska is proud to partner with the following organizations by providing support to the many scholarship and internship programs throughout Alaska. Open the links below to learn more about the different programs. To inquire about eligibility and available funding for the 2017/2018 academic year, please contact the partner organizations directly.

Partner Organization Contact Information Scholarship/Internship Focus

ANSEP.net

Alaska Native Science & Engineering Michael Bourdukofsky, P.E.

Chief Operations Officer | 907.786.6362 [email protected]

3211 Providence Drive, ANSEP 205 Anchorage, AK 99508

Science, Technology, Engineering, and Math (STEM) Degree Programs

Note: Recipients must be a participant of ANSEP at UAA or UAF

ahtna.inc.com

Ahtna, Inc. M. Starr Knighten, Shareholder

Development Coordinator907.822.3476 | [email protected]

PO Box 649 Glennallen, AK 99588

Construction Management, Health, Culinary, Safety/Environment, Project Management, Engineering, Project Controls, Accounting, Business, Economics, Finance, Security, Process Technology, Instrumentation Technology, Welding, Diesel/Heavy Equipment, Maritime

alaskapacific.edu

Alaska Pacific University Laura See, Development Specialist

907.564.8250 | [email protected] 4101 University Drive Anchorage, AK 99508

Master of Business Administration Degree Program

avtec.edu

AVTEC, Alaska’s Institute of Technology Kim Kain, Financial Aid Officer

907.224.6157 | [email protected] PO Box 889

Seward, AK 99664-0899

Diesel/Heavy Equipment, Welding, Industrial Electricity, Plumbing & Heating, Business & Office Technology, IT, USCG-approved Maritime Training, Construction trades, Culinary

beringstraits.com

Bering Straits Foundation Program Officer

Office: 907.443.4305 Fax: 907.443.2985 or 907.443.8129

[email protected] PO Box 1008

Nome, AK 99762

Engineering, Health Safety/Environment, Security, Construction Management, Project Management, Project Controls, Computer Science/MIS, Accounting, Business, Economics, Finance, Instrumentation Technology, Process Technology/SCADA, Welding, Diesel/Heavy Equipment, Electrician, Maritime, Culinary

bbnc.net

Bristol Bay Native Corporation Carol Wren, Vice President Shareholder Development

907.265.7868 | [email protected] 111 West 16th Avenue, Suite 400

Anchorage, AK 99501

Engineering, Computer Science, IT, Health & Safety, Construction Management, Project Management, Instrumentation Technology, Process Technology, Business, Accounting, Finance

calistacorp.com

Calista Corporation Brenda Pacarro, Workforce & Shareholder

Development Supervisor 907.275.2800 | [email protected]

5015 Business Park Blvd, Suite 3000 Anchorage, AK 99503

Internship - Environmental Science and Environmental Engineering Degree Programs

chugachheritagefoundation.org

Chugach Heritage Foundation Stephen Grantier, Program & Systems

Manager | 907.261.0400 [email protected]

3800 Centerpoint Drive, Suite 1200 Anchorage, AK 99503

Heavy Equipment/Truck Driver, Welding, Culinary, Construction Management, Business, Engineering

Cook Inlet Tribal Council, Inc. 3600 San Jeronimo Drive

Anchorage, AK 99508 citci.org/education/scholarships/

The CIRI Foundation 907.793.3575 or 800.764.3382

[email protected] thecirifoundation.org

Welding, Diesel/Heavy Equipment, CDL, HSE, Electrician, Maritime, Culinary, Engineering, Construction Management, Oilfield Support, Project Controls/Management, Computer Science/MIS, Finance, Accounting, Security, Business, Economics, Process Technology Instrumentation Technology/SCADA

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Partner Organization Contact Information Scholarship/Internship Focus

firstalaskans.org

First Alaskans Institute Dewey Hoffman, Leadership Development

Director | 907.677.1712 [email protected]

606 E Street, Suite 200 Anchorage, AK 99501

Internship - Engineering and Business Degree Programs

hunatotem.com

Huna Totem Corporation Katelyn Savland, Shareholder Relations

Manager | 907.789.8522 [email protected]

9301 Glacier Highway, Suite 200 Juneau, AK 99801

Internship - Accounting Degree Program

ilisagvik.edu

Iḷisaġvik College Caitlin Walls, Grant Writer & Strategist

907.855.0591 [email protected]

PO Box 749 Barrow, AK 99723

Business, Accounting, IT, Health & Safety, Construction Management

kpc.alaska.edu

Kenai Peninsula College Julie Cotterell, Student Services Director 907.262.0314 | [email protected]

156 College Road Soldotna, AK 99669

Process Technology, Instrumentation Technology, Welding

koniageducation.org

Koniag Education Foundation Jesse Kreger, Executive Director


4241 B Street, Suite 303B Anchorage, AK 99503

Engineering, IT, HSE, Business, Accounting, Audit, Quality, Inspection, Security, Project Controls, Planner/Scheduler, Construction Management, Project Management, Process Technology, Instrumentation Technology

nanaworleyparsons.com

NANA WorleyParsons, LLC Annette Zella, Program Development

Consultant | 907.265.4362 [email protected]

PO Box 111100 Anchorage, AK 99511

Process Technology, Drafting & Design, Engineering, Project Management, Business, Accounting, Health & Safety, Security, Environment

nitalaska.com

Northern Industrial Training, LLC. Patrick Rose, Student/Client Outreach

907.357.6400 or 907.982.8315 [email protected] 1740 North Terrilou Court

Palmer, AK 99645

Construction & TAPS Industry Trades, Welding, PTDI, Health & Safety Programs

sealaska.com

Sealaska Corporation Derik Frederiksen, Vice President Sealaska Government Services


One Sealaska Plaza, Suite 400 Juneau, AK 98001

Health & Safety/Environment, Security, Construction Management, Project Management, Project Controls, Computer Science/IT/MIS, or Accounting, Business, Economics, Finance

uaf.edu/som

University of Fairbanks School of Management (SOM)

Tammy Tragis-McCook, Director of Development & Outreach | 907.474.7042

[email protected] PO Box 756080

Fairbanks, AK 99775

Business Administration Degree Programs

uaf.edu/rahi

University of Fairbanks Rural Alaska Honors Institute (RAHI) Denise Wartes, Program Manager

907.474.6886 | [email protected] PO Box 756305

Fairbanks, AK 99775

Residential Summer Bridging Program for high school students pursuing Process Technology

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