Term/Semester applying for: _____________________________________ Applying as:          freshman;          transfer student;

Legal Name: _____________________________________________________________________ Male Female

Last First Middle

Address For Reply: ______________________________________________________________________________________________________

(Where 1-20 will be sent)

______________________________________________________________________________________________________________________

Telephone: _________________________________ Fax: ___________________________________

E-Mail: ____________________________________

Citizen of: __________________________________ Date of Birth: ____________________________

Month Day Year

Married: ______ Yes ______ No

Language spoken at home: ________________________________________________________________________________________________

Possible study curriculum/major: ___________________________________________________________________________________________

College or division if applicable: ___________________________________________________________________________________________

Possible career choice: ___________________________________________________________________________________________________

Current School/College: __________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Date of entry: __________________________________________________________________________________________________________

Current level of education: ________________________________________________________________________________________________

Expected date of graduation: ______________________________________________________________________________________________

List all other Schools/Colleges and programs you have attended beginning with the ninth grade
 

Name of School/College	Location	Class/Program	Dates attended

ACADEMIC HONORS( Briefly describe any scholastic distinctions or honors you have received)

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

TEST INFORMATION( Please list your test plans below)

SAT I

Date taken/to be taken: ____________________________________________

Scores: Verbal: ___________________ Math: _________________________

SAT II Subject Tests

Date taken/to be taken: _____________________________ Subject: _________________ Score: __________________

Subject: _____________ Score: ______________________ Subject: _________________ Score: __________________

ACT

Date taken/to be taken: __________________

English _________ Math ___________ Reading ____________ Science ___________ Composite _________________

Test of English as a Foreign Language( TOEFL )

Date taken/to be taken: ___________________________ Score: ___________________

FAMILY INFORMATION

MOTHER

Mother's Full Name: _____________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Occupation: ___________________________________________________________________________________________________________

Name of business/organization: ____________________________________________________________________________________________

College where studied (if any): ____________________________________________________________________________________________

Degree: _________________________________________________ Year: ________________________________________________________

FATHER

Father's Full Name: _____________________________________________________________________________________________________

Address: ______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Occupation: ___________________________________________________________________________________________________________

Name of business/organization: ____________________________________________________________________________________________

College where studied (if any): _____________________________________________________________________________________________

Degree: _________________________________________________ Year: ________________________________________________________

Parent's Marital Status: ___________________________________________________________________________________________________

Please give names and ages of your brothers and sisters. If they have attended college, list the names of the institutions attended, degrees earned, and approximate dates:
 

Name	Institution attended	Degree earned	Year

EXTRACURRICULAR ACTIVITIES

Please list your principal extracurricular, personal, volunteer, community, and family activities and hobbies in the order of their interest to you. Include specific events and/or major accomplishments such as leadership positions held, varsity letters earned, etc.

 
 

Activity	Grade level	Positions held, honors won, or letters earned

WORK EXPERIENCE

List any job (including summer employment) you have held during the past three years:
 

Specific nature of work	Employer	Approx. dates ofEmployment	Approx. no. of hours per week

PERSONAL STATEMENT

This personal statement helps admissions staff become acquainted with you as an individual in ways different from courses, grades, test scores, and other objective data. Please write an essay (250-500 words) on a topic of your choice or on one of the options listed below:

1. Evaluate a significant experience or achievement that has special meaning to you.
2. Discuss some issue of personal, local, national, or international concern and its importance to you.
3. Indicate a person who has had a significant influence on you, and describe that influence.

I indicate that all information in my application is complete, factually correct, and honestly presented

Signature: _______________________________________________ Date: _________________________________

Name of Applicant: ______________________________________________________________________________

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