common app 2011
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8/8/2019 Common App 2011
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2010-11 First-year ApplicationFor Spring 2011 or Fall 2011 Enrollment
AP-1 / 2010© 2010 The Common Application, Inc.
APPLICANT
Legal Name _________________________________________________________________________________________________________________Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.
Preferred name, if not first name (choose only one) ______________________ Former last name(s), if any _____________________________________
Birth Date ____________________________________ US Social Security Number, if any _________________________________mm/dd/yyyy
Optional, unless applying for US Federal financial aid with the FAFSA f
Home (_______) __________________________________ Cell (_______) ________________________________ Area/Country/City Code Area/Country/City Code
E-mail Address ________________________________________________ IM Address ______________________ _________________________
Permanent home address _______________________________________________________________________ _____________________Number & Street Apartment #
______________________________________________________________________________________ ________________City/Town County or Parish State/Province Country ZIP/Postal Code
If different from above, please give your current mailing address for all admission correspondence. ___ to __________(mm/dd/yyyy) (mm/dd/yyyy
Current m ailing address _ __________________________________________________________ ___________________ Number & Street Apartment #
________________________________________________________________________ ________________________City/Town County or Parish State/Province Country ZIP/Postal Code
If your current mailing address is a boarding school, include name of school here: _______ _____________________________
FUTURE PLANS
Your answers to these questions will vary for different colleges. If the online syst of the questions you see in this section, this collechose not to ask that question of its applicants.
College ________________________________________________ _____________________________________________mm/dd/yyyy
Entry Term: Fall (Jul-Dec) Spring (Jan-Jun)
Decision Plan_________________________________
Academic Interests ________________________
___________________________________
________________________________ __
Career Interest_________________ ______
d to apply for need-based financial aid? Yes N
ntend to apply for merit-based scholarships? Yes N
you intend to be a full-time student? Yes N
Do you intend to enroll in a degree program your first year? Yes N
Do you intend to live in college housing?____________________________
DEMOGRAPHICS
Female Male
Citizenship Status _ ___________________
Non-US Citizenship ____ ______________________
______________________ __________________________
__________________________ _____________________________
Years lived in the US? ____________________________________________
Birthplace ________________________________________________________ City/Town State/Province Country
Optional The items with a gray background are optional. No information youThe items with a gray background are optional. No information youprovide will be used in a discriminatory manner.provide will be used in a discriminatory manner.
Marital StatusMarital Status ________________________________________________________________________________________________________
US Armed Services veteran?US Armed Services veteran? Yes Yes NoNo
1.1. Are you Hispanic/Latino? Are you Hispanic/Latino?
Yes, Hispanic or Latino (including Spain) Yes, Hispanic or Latino (including Spain) NoNo
Please describe your background _____________________________________________
2.2. Regardless of your answer to the prior question, please indicate how you identiRegardless of your answer to the prior question, please indicate how you identiyourself.yourself. (Check all that apply.)(Check all that apply.)
American Indian or Alaska Native (including all Original Peoples of the Americas) American Indian or Alaska Native (including all Original Peoples of the Americas)
Are you Enrolled? Are you Enrolled? Yes Yes No If yes, please enter Tribal Enrollment Number_____________No If yes, please enter Tribal Enrollment Number_____________
Please describe your background _____________________________________________
Asian (including Indian subcontinent and Philippines) Asian (including Indian subcontinent and Philippines)
Please describe your background _____________________________________________
Black or African American (including Africa and Caribbean)Black or African American (including Africa and Caribbean)
Please describe your background _____________________________________________
Native Hawaiian or Other Pacific Islander (Original Peoples)Native Hawaiian or Other Pacific Islander (Original Peoples)
Please describe your background _____________________________________________
White (including Middle Eastern)White (including Middle Eastern)
Please describe your background _____________________________________________
_____
___________
_______________________ _Country ntr
(from ______________mm/dd/ m/dd
___________________________ ____ __
___________________________ ____Country
____________________________ __
PLANS
m did not ask you to answer someid ou some
___________ Deadline ______ea
___________________ _
________________________ ___
__________________________ ____ __
____________________________ __ ___ __
___________________________ __ _
Do you inteu
Do you
Do
___________________________ __
_____________________ __
_______________
______
Preferred Telephone Home Cell
C ou nt y r Pa ri sh
C ou nt y r Pa ri sh
What is the highest degree you intend to earn? _______________________
Are you proficient in any other languages?_______________________________
_________________________________________________________________
Religious PreferenceReligious Preference ______________________________________________________________________________________________
First
Primary language spoken at home _____________________________________
_________________________________________________Language
lease lease escribe escribe your your ackground ackground
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FAMILY
Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information fordemographic purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then pleaselist that information below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the AdditionalInformation section.
Household
Parents’ marital status (relative to each other): Never Married Married Widowed Separated Divorced (date ______________________mm/yyyy
With whom do you make your permanent home? Parent 1 Parent 2 Both Legal Guardian Ward of the Court/State Other
Legal Guardian (if other than a parent)
Relationship to you _________ ___________
___________________ _______________Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
Home address if diffe
_____________________ ________________________
_________________________ _____________________________
Preferred Telephone: Home ell Work
(_______) ____________________________________________________ Area/Country/City Code
E-mail _______________________________________________________
Occupation _____________________________________________________
Employer _____________________________________________________
College (if any) ___________________________________ CEEB________
Degree _________________________________________ Year _________
Graduate School (if any) ____________________________ CEEB________
Degree _________________________________________ Year _________
SiblingsPlease give names and ages of your brothers or sisters. If they are enrolled ingrades K-12 (or international equivalent), list their grade levels. If they haveattended or are currently attending college, give the names of the undergraduateinstitution, degree earned, and approximate dates of attendance. If more thanthree siblings, please list them in the Additional Information section.
__________________________________________________________Name Age & Grade Relationship
College Attended ___________________________________ CEEB _____
Degree earned _________________________ Dates ________________
r expected mm/yyyy – mm/yyyy
__________________________________________________________Name Age & Grade Relationship
College Attended ___________________________________ CEEB _____
Degree earned _________________________ Dates ________________r expected mm/yyyy – mm/yyyy
__________________________________________________________Name Age & Grade Relationship
College Attended ___________________________________ CEEB _____
Degree earned _________________________ Dates ________________r expected mm/yyyy – mm/yyyy
Parent 1: Mother Father Unknown
Is Parent 1 living? Yes No (Date Deceased ____________________)mm/yyyy
____________________________________________________________Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
Country of birth ________________________________________________
Home address if different from yours
____________________________________________________________
____________________________________________________________
(_______) ____________________________________________________ Area/Country/City Code
E-mail _______________________________________________________
_________________________________________________
____________________________________________
___________________________________
Degree ____________________________________
__________________
Degree __________________________ __
Parent 2: Mother Father Unknown
Is Parent 2 living? Yes No (Date Deceased __________________mm/yyyy
_____________________________ ______________________Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., e
Country of birth ___________ ________________
Home address if different f
_______________ _________________
__________ ______________________
(___ _____________________________ Area/Country/City Code
__________________________________
________________________________________
____________________________________________
) ___________________________________ CEEB______
_________________________________________ Year _______
raduate School (if any) ____________________________ CEEB______
Degree _________________________________________ Year _______
___
_________
EEB_E ________
______ Year ___________
____________ CEEB_EB _______
_________________ ___ Year ____ Ye ______
_______n
_____________________ __
om yoursu
_____________________________ __ _
___________________________ ___ _
___)) ______ ___________________ /Country/City /City Code de
E-mail __________________ail _ __ __
Occupation __________n __ _
Employer _______m _
College (if ang
Degre
n n t) t)
________________________________
____________________________ __ ___i rst Given n Middl Mid
entent from yourss
________________
________
Preferred Telephone: Home Cell Work Preferred Telephone: elep Home Celll Work
Occupation
Employer
College (if any)
Graduate School (if any)
Age & Grade
Age & Grade
Age & Grade
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AP-4 / 2010© 2010 The Common Application, Inc.
Honors Briefly list any academic distinctions or honors you have received since the 9 th grade or international equivalent (e.g., National Merit, Cum Laude Society).
Grade level or
post-graduate (PG)
Honor Level of Recognition
School State/ National Inte9 10 11 12 PG Regional natio
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE
Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance t ee to group your activities apaid work experience separately if you prefer. Use the space available to provide details of your activities and accompli vents, varsity letter, mus
instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this sect tach a résumé.
Grade level or
post-graduate (PG)
Approximate
time spent
When did you participate
in the activity?Positions held, honors won, letters earned, or employer
If applicable
do you plan
to participat
in college?9 10 11 12 PG Hours
per week Weeks
per yearSchool
year
Summer/SchoolBreak
__________________ ______________________________________ ____________________
___________________________________________________________ _______________________________________________________________________________________ ____________________________
_________ _____________________________
Activity __________________________________________________ ____________________________________
__________________________________________________________________________
Activity Activity __________________________________________ _______________________________________________________________________________________ _____________________________________________
______________________________________________
Activity _________________________________ ______________________________________________________
______________________________________________________________________________________________________________
Activity Activity ________________________ ______________________________________________________________________________________ ______________________________________________________________
_______________________________________________________________
Activity ________________ _______________________________________________________________________
________________________________________________________________________________________________________________________________
Activity Activity _________ _________________________________________________________________________________________ ________________________________________________________________________________
________________________________________________________________
Activity ___________________ _________________________________________________________________________________________
________________________________________________________________________________________________________________________________ Activity Activity __________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________
Activity _________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Activity Activity __________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________
Activity _________________________________________________________________________________________________________________
E
you. Feel fFeements (specific eeci
n even if you plan to an eve la
on, letters earned,, le d,, le d,
_____________________________________________________ ______ ___
_____________________________________________________ __ _____ __ __
_________________________ ___ ___ __
__________________________ ___ __
____________________________________________________ ___ _
___________________________________________________ _____ __ _____ _
___________________
___________________________ __
________________________
____________________________________________________ __ ___ ____ __ ___ __
__________________________ _____
_________________________________________________ _____ __
_______
& WO& WOR R K K
or employeror employer
Activity Activity
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WRITING
Short Answer Please briefly elaborate on one of your extracurricular activities or work experiences in the space below or on an attached sheet
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Personal Essay Please write an essay (250 words minimum) on a topic of your choice or on one of the options listed below, and attach it to your applicationbefore submission. Please indicate your topic by checking the appropriate box. This personal essay helps us become acquainted with you as a person and
tudent, apart from courses, grades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and express yourself.
Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and it
Discuss some issue of personal, local, national, or international concern and its importance to you.
Indicate a person who has had a significant influence on you, and describe that influence.
Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) t explain that influenc
A range of academic interests, personal perspectives, and life experiences adds much to the e background, describeexperience that illustrates what you would bring to the diversity in a college community or an portance of diversity to you.
Topic of your choice.
Additional Information If there is any additional information you’d like to provide regardin qualifications, etc., please do so in thespace below or on an attached sheet.
_____________________________________________________________ ___________________________________
_________________________________________________________ _______________________________________
_____________________________________________________ ___________________________________________
________________________________________________ _______________________________________________
Disciplinary History Have you ever been found responsible for a disciplin ution you have attended from 9th grade (or the international equivalent)
forward, whether related to academic misconduct ted in your probation, suspension, removal, dismissal, or expulsion fromthe institution? Yes No
Have you ever been adjudicated guilty or co r other crime? Yes No
If you answered “yes” to either or both sheet of paper that gives the approximate date of each incident, explains the circumstances, anreflects on what you learned from t
SIGNATURE
Application Fee Payment s an application fee, how will you be paying it?s an application fee, how will you be paying it?
Online PaymentOnline Payment Online Fee Waiver RequestOnline Fee Waiver Request Will Mail Fee Waiver RequestWill Mail Fee Waiver Request
Required Signature
I I certify certify that that all all information information sub tted sub tted in in the the dmission dmission process-including process-including he he application,application, the the personal personal essay,essay, ny ny upplements,upplements, and and any any other other supporting supporting
materials-is materials-is my my own own work,work, factually factually true,true, and and honestly honestly presented,presented,I I understand understand that that I I may may be be ubject ubject to to range range of of possible possible disciplinary disciplinary ctions,ctions, including including admission admission revocation,revocation, expulsion,expulsion, or or
should should he he information information I I have have certified certified be be false.false. I I cknowledge cknowledge that that I I have have reviewed reviewed the the pplication pplication instructions instructions for for each each college college receiving receiving this this application.application. I I understand understand that that all all offers offers of of admission admission are are conditionalconditional
pending pending receipt receipt of of final final transcripts transcripts howing howing ork ork comparable comparable in in quality quality to to that that upon upon which which he he offer offer as as based,based, s s ell ell s s honorable honorable dismissal dismissal from from he he school.school. I I ffirm ffirm that that I I ill ill send send an an enrollment enrollment deposit deposit (or (or equivalent) equivalent) to to only only one one institution; institution; sending sending multiple multiple deposits deposits (or (or equivalent) equivalent) may may result result in in he he withdrawal withdrawal of of my my
dmission dmission offers offers from from ll ll institutions.institutions. [Note: [Note: tudents tudents may may send send n n enrollment enrollment deposit deposit (or (or equivalent) equivalent) to to econd econd institution institution where where they they have have been been dmitted dmitted from from the the waitlist,waitlist, provided provided that that they they inform inform he he first first institution institution that that hey hey ill ill no no longer longer be be enrolling.] enrolling.]
ignature _______________________________________________________________________________________________ Date __________________ignature _______________________________________________________________________________________________ Date __________________mm/dd/yyyy
impact on you.yo
at has had an influence on you, ana in ou, a
ucational mix. Given your personal nencounter that demonstrated the ienc emo te
special circumstances, additionalspe st
_________________________ ___ ___ __
___________________________ ___
___________________________ __
__________________________ _____ _
y violation at any educational instiy v nyr behavioral misconduct, that resr be isc
victed of a misdemeanor, felony,victe de y,
questions, please attach a separateque ee experience.erie
mmm If this college requirIf this college requirhishis
ill Mail Paymentill Mail Paymentill Maiill Mai
(150 words or fewer)
NOTE: Your Common Application essay should be the ame for l l col leges.Do not customize it in any way for individual colle e olle es hat want customized ..
essay responses will sk for hem on uppl ement form.
[Note that you are not required to answe n explanation, if the criminal adjudication or conviction has been expunged, sealed,“yes” to this question, or provide“y ” thi n, o deannulled, pardoned, destroyed, erase by a court to be kept confidential.], impounded, or otherwise ordere, i , or ord re
nd nd hat hat these these documents documents will will become become the the property property of of he he institutions institutions to to hich hich I I m m pplying pplying nd nd ill ill not not be be returned returned to to me.me.
revocation revocation of of course course credit,credit, grades,grades, nd nd degree degree
Common Common Application Application membe membe r r insti insti ution ution dmis dmis sion sion offic offic es es do do not not discr discr iminate iminate on on the the basis basis of of race,race, color color ethni ethni city,city, natio natio nal nal origi origi n,n, relig relig ion,ion, creed creed ,, exexge,ge, marit marit l l statu statu ,, paren paren tal tal tatu tatu s,s, physi physi cal cal disab disab ility,ility, learn learn ing ing disab disab ility,ility, polit polit cal cal affil affil iation,iation, veter veter n n statu statu ,, or or sexua sexua l l orien orien tation.tation.
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