common app 2011

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_____________


Asian (including Indian subcontinent and Philippines) Asian (including Indian subcontinent and Philippines)


Black or African American (including Africa and Caribbean)Black or African American (including Africa and Caribbean)


Native Hawaiian or Other Pacific Islander (Original Peoples)Native Hawaiian or Other Pacific Islander (Original Peoples)


White (including Middle Eastern)White (including Middle Eastern)


_____

___________

_______________________ _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

8/8/2019 Common App 2011



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



Degree earned _________________________ Dates ________________r expected mm/yyyy – mm/yyyy



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

8/8/2019 Common App 2011


8/8/2019 Common App 2011



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

8/8/2019 Common App 2011



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.

common app 2011

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