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First Name		Last Name
Parent First Name		Parent Last Name
Address
City		State
Zip Code
Phone Number
Parent Email
Male Female
Birth Date		Religion
Intended Major
Ethnic Origin African-American/Black American Indian/Native Alaskan Asian or Pacific Islander Hispanic White Other
List Heritage / Nationality (ex. Italian, Dutch, French, Irish ) List Heritage / Nationality
Grade Point Average..on a scale 0.0 - 4.0
SAT Math Score
SAT Crit. Read Score
SAT Writing Score
ACT Score
Class Ranking
High School
Graduation Date
College Considering
Are you currently attending college? Yes No
What year of college are you in?
What is the name of the College you are attending?
If your planning to transfer, where to?
Are you a returning college student? Yes No
If yes, how many years have you been away from college?
Is either parent an alumni of the school you are considering? Yes No
Are you a 1st generation college student? Yes No
List Student Organizations (ex. 4-H, church member, student Council, SADD) List Organizations
Academic Honors (NHS, Awards) List Honors
Are you interested in scholarships that require documentation of financial need????? Definitely Not sure No
Are there any hardships in your family? If so list them. List Hardships
Are any of your parents deceased? Please list. Parents Deceased
Any of your parents die in the line of duty? Yes No
Are any of your parents a Firefighter? Yes No
Are any of your parents a Police officer? Yes No
Are you related to a Firefighter? Yes No
Are you related to a Police officer? Yes No
Have you been affected in anyway from the tragedy on 9/11 ? Please list. 9/11 Tragedy
Do you or anyone in your family suffer from: MS Turret's Epilepsy None
Are you gay? Yes No
Are any of your parents gay? Yes No
Any other family members gay? Yes No
Does anyone in your family have, recovered or died from Breast Cancer? Yes No List Family Members
Do you have any kind of hearing loss? Yes No
Do you have any kind of Asthma? Yes No
Do you have any kind of Blindness? Yes No
Do you have any kind Diabetes? Yes No
Are you interested in organizing a blood drive? Yes No
What is your height?
Do you skateboard? Yes No
Are you left-handed? Yes No
Any special talents? List your talents
Any special interests? List your interests
Do you like to write stories? Yes No
Do you like to write poetry? Yes No
Did you ever write for the school paper? Yes No
Sports played in High School? Sports Played
Are you planning on playing sports in college? Yes No
Are you a vegetarian? Yes No
Parents occupations? Parents Occupations
Parents military involvement? Parents Military Involvement
Other family members military involvement? Family Military Involvement
Any killed in the line of duty? Please list. Family Killed
Parents associations and memberships? (ex. American Legion, Lions Club, ELKS, Unions, etc) Parents Associations
Artistic Abilities (band, chorus, dance, photography, music, theatre, ) Artistic Abilities
Do you participate in any Junior Achievement classes in HS? Please list Junior Achievement
Are you interested in any scholarships where you have to make a poster? Yes No
Are you interested in any scholarships where you have to make a video? Yes No
Are you a member of DECA ? Yes No
Are you/or were you a Boy Scout? Yes No
Are you/or were you an Eagle Scout? Yes No
Are you/or were you a Girl Scout? Yes No
Did you/do you own or operate your own business while in high school? Yes No
Last chance��is there anything you want to add about yourself and your family????? Last Chance
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