Name of Applicant:
Address:
City:
State:
Zip Code:
Name of Parent(s) or Guardian(s):
Telephone Number:
E-mail:
High School:
School Phone Number:
University or College you plan to attend:
Intended Major (if known):
Current GPA:
Identify the activities in which you have been involved by circling the number of
years you have participated in each.
High School Honors and Awards:
Have you had an opportunity to be employed or participate in any volunteer work
and/or community activities
during your high school years? Please list and describe.
Summary of your college plans:
Summary of your career plans:
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