| STUDENT'S (LEGAL) FIRST NAME * |
|
| STUDENT'S MIDDLE NAME * |
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| STUDENT'S LAST NAME * |
|
| STUDENT'S NICKNAME/PREFERRED NAME * |
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| HIGH SCHOOL * |
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| STUDENT'S BIRTH DATE * |
|
MAILING ADDRESS *
(Street)
(City, State, and Zip Code) |
|
STUDENT'S CELL PHONE NUMBER
|
|
| DO YOU TEXT MESSAGE? * |
YES
NO
|
| STUDENT'S EMAIL ADDRESS * |
|
FAMILY HISTORY
(please select all that apply)
|
PARENTS MARRIED
PARENTS SEPARATED
PARENTS DIVORCED
FATHER REMARRIED
MOTHER REMARRIED
FATHER DECEASED
MOTHER DECEASED
|
STUDENT LIVES WITH
(please select all that apply)
|
FATHER
MOTHER
STEPFATHER
STEPMOTHER
GUARDIAN
|
| FATHER'S NAME * |
|
| FATHER'S UNDERGRADUATE ALMA MATER (if applicable) |
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| FATHER'S UNDERGRADUATE DEGREE & MAJOR (if applicable) |
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| FATHER'S GRADUATE ALMA MATER (if applicable) |
|
| FATHER'S GRADUATE DEGREE (if applicable) |
|
| FATHER'S EMPLOYER |
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| FATHER'S EMAIL ADDRESS * |
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| MOTHER'S NAME * |
|
| MOTHER'S UNDERGRADUATE ALMA MATER (if applicable) |
|
| MOTHER'S UNDERGRADUATE DEGREE & MAJOR (if applicable) |
|
| MOTHER'S GRADUATE ALMA MATER (if applicable) |
|
| MOTHER'S GRADUATE DEGREE (if applicable) |
|
| MOTHER'S EMPLOYER |
|
| MOTHER'S EMAIL ADDRESS * |
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| SIBLING 1'S NAME (if applicable) |
|
| SIBLING 1'S AGE (if applicable) |
|
| SIBLING 1'S SCHOOL (if applicable) |
|
| SIBLING 2'S NAME (if applicable): |
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| SIBLING 2'S AGE (if applicable): |
|
| SIBLING 2'S SCHOOL (if applicable): |
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| SIBLING 3'S NAME (if applicable): |
|
| SIBLING 3'S AGE (if applicable): |
|
| SIBLING 3'S SCHOOL (if applicable): |
|
DO YOU HAVE OTHER SIBLINGS?
|
YES
NO
|
|
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THE QUESTIONS BELOW MAY AID IN
FINDING APPLICABLE SCHOLARSHIPS.
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RELIGIOUS AFFILIATION (optional)
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ETHNIC BACKGROUND (optional)
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ESSENTIAL ELEMENTS: