Name:___________________________________ Telephone#:__________________________

Address:_________________________________ Date:________________________________

Father: Name:___________________________ ; Occupation:___________________________

Mother: Name:___________________________ ; Occupation:__________________________

Number of children in family:____________ ; Number in college:_________________________

List any unique or special financial situations:________________________________________

______________________________________________________________________________

Name of college you plan to attend:________________________________________________

Anticipated annual tuition: $____________________ ; Anticipated major:_________________

List any school and community activities:____________________________________________

List any work experience:

Employer:                                          Job:                                         Dates of employment:      _____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

REQUIRED SUBMISSION DOCUMENTS:

1) Transcript - please provide your current, up to date school transcript.
2) Two letters of recommendation (teachers, administrators or community leaders who are familiar
with your involvement and can comment on your potential and accomplishments.
3) Paragraph - please write a short paragraph stating your career goals (use separate sheet).
4) Other - you may provide other documents which you believe will help your application.