Personal Information
Name:
Address:
City/State/Zip:
Telephone:
Best Time to Call: 
Email:
Social Security No:
Current Grade 
Point Average:		 (Student must have a B average to apply)
SAT(Critical Reading):
SAT (Math): 
SAT (Writing): 
ACT  Composite Score: 
Tell us...

What do you want/expect from a college education:

Provide your mini-autobiography 10 years from now.  In other words, write a brief “fact sheet” that might be used for you 10 years from now as a press release.

What is the most exciting or thrilling thing that has ever happened to you?

Describe an experience that you feel has changed your life.

What is the most important thing you would like to convey to us about yourself?

References

Please provide the names, positions, and telephone numbers of two references. At least one should be acquainted with your current academic record. Then sign and date the form.

Name:

Position:

Home  Telephone:

Office  Telephone:
 

Name:

Position:

Home  Telephone:

Office  Telephone:

Signature:

Date: