Major: Student ID#:

Email:

Home Address:

Date of Birth:
  __ __ __ __ ______________ ______________ ______________ ______________ ______________ ____ ____ ____ ____ ____

Place of Birth:



SAT/ACT Scores:
Math: Verbal: Total:

Are you presently enrolled at a College or University?
yes
no

If so, where?:

If not, have you applied for admission?
yes
no

Have you been accepted?
yes
no

At the beginning of Fall Semester:
How many credit hours will you have earned?

What will be your class standing?
Freshman Sophomore Junior Senior

How many additional semester hours will you need to complete your Bachelors degree?

When do you expect to complete your Bachelors degree?
Semester: Year:

Describe your participation in the following activities and programs:

Community Service Activities:


Student Clubs and Activities: ( including 4-H, FFA, Band, Football ect. – list years and offices held – specify high school or college):

Honors and Awards Received: (specify high school or college):


List all scholarships you hove received in previous years and expect for the academic year: (source, amount, and years):

What are your academic interests and career plans?


References:

List three references: (who are not related to you):

Reference 1

Name:    

Address:

Parents

Father's name: 


Father's occupation:


Father's place of employment:

Mother's name: 


Mother's occupation:


Mother's place of employment:



Work Experience:

Employer 1:

Employer 2:

Employer 3:

Education:

School 1

School 2

School 3

Hometown Newspaper:

Name:

Address: