Last Name ______________________ First________________ e-mail_______________________________
Home address _____________________________________ City ___________________ Zip___________
U.S. Citizen (circle)? Yes No SAT Scores: Verbal ______ Math ______ Writing_____ Date _________
Academic Activities: Please indicate honors and AP courses both completed and in progress:
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Honors Courses Completed |
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AP Courses Completed |
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Honors Courses In Progress |
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AP Courses In Progress |
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Honors/Awards, special recognition received for school or community service activities.
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Name of Award |
Date Rec’d |
Name of Award |
Date Rec’d |
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Activity |
Member |
Officer |
Volunteer |
Selected/Appointed |
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National Honor Society |
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Beta Club |
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Student Council |
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Class Officer |
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School Newspaper |
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Yearbook |
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Debate Society |
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School Band/Orchestra/Chorus |
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School Subject Related Club |
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Drama/Performing Arts |
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Varsity Sports Team |
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Other |
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Community Service during Junior or Senior year (elaborate on the back of this sheet):
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Activity |
Participant |
Hours per Week |
Officer |
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Church/Religious Group |
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Boy/Girl Scouts |
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Ethnic/Cultural Organization |
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Health/Safety Group |
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Peer Counseling |
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Tutoring |
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Community Improvement Project |
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Performing Arts |
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Recreation Project |
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Drug Awareness Hotline |
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Other |
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