PERSONAL DATA

  1. Name______________________________________________________________

    2.  
  2. Address____________________________________________________________

    3.  
  3. Date/Place of Birth____________________________________________________

    4.  
  4. Name of Father______________________________________________________

    5.  
  5. Name of Mother______________________________________________________

    6.  
  6. Address____________________________________________________________

    7.  
  7. College/University applicant plans to attend__________________________________
  EDUCATIONAL BACKGROUND (Enclose official high school transcript)

  1. Name/Address of High School______________________________________________

  2. Honors/Awards received__________________________________________________

  3. Indicate Courses of Most Interest____________________________________________

  4. Participation in Extracurricular School activities: List Offices Held__________________________________________________________________ _____________________________________________________________________

  5. Participation in outside community activities, directly or indirectly related______________
    ____________________________________________________________________

  6. Has applicant been working while attending school? _____________________________
    If so. Where, how long, and salary__________________________________________
    _____________________________________________________________________

  7. In your own words, please state the course of study you plan to pursue and your general outlook as to future endeavors. (use separate sheet if necessary)_____________________
    _____________________________________________________________________
    _____________________________________________________________________
    _____________________________________________________________________
    _____________________________________________________________________

    Signature of applicant_____________________________________________________
    Signature of Principal/School Counselor_______________________________________

    Please submit completed application with transcript of high school record. Thank you and best of luck!