Form II – Page 1 Applicant Number__________

What is your proposed field of study? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Why have you chosen this field of study?

________________________________________________________________________________________________________________________________________________________________________________________________________________________

SCHOOLS ATTENDED:

Middle School:___________________________________________________________ Name of School City or County

High School:_____________________________________________________________

Name of School City or County

FAMILY STATUS:

Parents: Living__________ Divorced__________

Deceased – Father ________ Mother___________

How many children are in the family? Brothers_______ Sisters________

What are their ages?___________________________________________________

Are any other members of your family attending college?_____________________

How many?_____________ What year?____________________________

Is anyone dependent on you for support?___________________________________

What high school or college honors have you received? ________________________________________________________________________________________________________________________________________________________________________________________________________________________

FORM II – Page 2 APPLICANT NUMBER_____

What high school or college student body offices have you held?

________________________________________________________________________________________________________________________________________________

Name special activities that you have participated in during high school or college?

________________________________________________________________________________________________________________________________________________

What work experience have you had?

________________________________________________________________________________________________________________________________________________

What are your volunteer experiences?

________________________________________________________________________________________________________________________________________________

Describe an aspect of your life of which you are exceptionally proud.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Briefly describe any special circumstances of which the committee should be aware.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Grade Point Average_____________________

Please attach a letter of recommendation from a college staff member.