Application - page 1

All information must be complete before application will be considered. Please print legibly.
 (Use separate sheet of paper if necessary)

NAME:

MAILING ADDRESS:

DATE OF BIRTH:

EMAIL:

TELEPHONE:

 (Home)

 (Cell)

ARE YOU CURRENTLY EMPLOYED? No Yes

PLEASE LIST YOUR EMPLOYMENT OR VOLUNTEER HISTORY:

FATHER’S NAME:

OCCUPATION:

MOTHER’S NAME:

OCCUPATION:

NUMBER OF CHILDREN & AGES IN FAMILY:

BESIDES YOURSELF, ANY FAMILY MEMBERS ATTENDING COLLEGE: No Yes

HIGH SCHOOL NAME:

HIGH SCHOOL GPA:

COLLEGE(S) YOU HAVE APPLIED TO:

COLLEGE(S) YOU HAVE RECEIVED ACCEPTANCE TO:

HAVE YOU MADE A FINAL SELECTION OF A COLLEGE?: No Yes (which one?)

PROGRAM/MAJOR YOU ARE INTERESTED IN:

BRIEFLY EXPLAIN YOUR EDUCATIONAL AND CAREER GOALS:

DESCRIBE YOUR COMMUNITY SERVICE, INCLUDING DATES: