Applicant First Name * Last Name * Address * Email *
Phone Number * Date of birth *
MM slash DD slash YYYY High School Information - Currently Attending List the high school you are attending and the date you expect to graduate. College undergraduates, please list the high school that you graduated from. Name of high school you are currently attending * Date of entrance *
MM slash DD slash YYYY Date of anticipated graduation *
MM slash DD slash YYYY Post-High School Education Already Acquired List here any college education you have acquired. Pick the one that best applies: Name of college or university Date of entrance
MM slash DD slash YYYY Date of anticipated graduation
MM slash DD slash YYYY Field of study / Anticipated degree What course of study (major) would you like to follow in college? Colleges and Universities Please name the colleges and universities that you are considering attending following graduation. College / University #1 Status of Application Have applied Have been accepted and will attend this institution Have been accepted and not made a decision on attending College / University #2 Status of Application Have applied Have been accepted and will attend this institution Have been accepted and not made a decision on attending Extracurricular Activities (for all applicants)
In the box below, please list any high school/university-sponsored or community-sponsored activities that you have participated in during the past three years. Applicants must include name of activity, grades in which you participated in the activity, and positions you held, and honors or letters earned. (i.e., Student Council, 10th-12th grade, Vice President 11th grade, President 12th grade) Please separate activities with returns.
Leisure Interests and Hobbies
Please indicate your leisure interests or hobbies, noting any accomplishments.
Please list any jobs (including summer employment) you have held in the past three years. Applicants must list position title, employer, approximate dates for employment, and approximate number of hours worked per week. (i.e., server, IHOP, June 2013-May 2015, 15 hours per week). Please separate each job entry with a return.
Extras - Personal Statement
If you think that the information provided in this application does not present a clear picture, or if you feel there are any special circumstances that should be taken into consideration when the committee reviews your application, please provide a personal statement here.
Application Essay * Please respond to ONE of the two items listed below. Describe the one interest or activity (in or out of school) that has most engaged your time and energy within the past three years and to which you feel you have made the strongest commitment. How do you evaluate the results of your involvement in this endeavor? Clearly describe your role in it. OR Discuss your plans for the future, including choice of a career, and how you plan to prepare yourself for that career.