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First Name:*  Middle Initial: Last Name:* Address:* City, State, Zip:*  AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming  Student Home Phone:     (XXX) (XXXXXXX) Student Mobile Phone:     (XXX) (XXXXXXX) Student E-mail: Parent/Guardian E-mail: Preferred method of contact (choose one): E-mail Home Phone Mobile Phone U.S. Mail Clear choices   Date of Birth:*   (MM-DD-YYYY) Gender: Male Female Clear choices   Ethnic Background: American Indian or Aleut Asian or Pacific Islander Black or African American Caucasian Latin American or Hispanic Mexican American or Chicano Puerto Rican Other Clear choices High School CEEB No:   Other High School Graduation Year:* Estimated Current GPA: (range 0.0 to 4.0) PSAT Verbal or Critical Reading Score: (range 20 to 80) PSAT Math Score: (range 20 to 80) PSAT Writing skills Score: (range 20 to 80) SAT Verbal or Critical Reading Score: (range 200 to 800) SAT Math Score: (range 200 to 800) SAT Writing skills Score: (range 200 to 800) PLAN Score: (range 17 to 32) ACT Score: (range 17 to 36) Please indicate your top choice for field of study: (select only one) Architecture Art, General Biology, General Business Administration And Management, General Communications, General Computer And Information Sciences, General Dance Education, General Engineering, General Health Science Humanities/Humanistic Studies Mathematics Music, General Physical Sciences, General Pre-Law Studies Pre-Medicine Studies Social Sciences, General Undecided   For each item, check the appropriate column if you participate in this activity in high school or expect to participate it in college. (check all that apply) HS College Academic Interest Groups         Arts         Community service         Debate         Drama and theatrical production         Intramural sports         Junior varsity and varsity athletics         Music, including chorus, band, orchestra         National Honor Society         Political/social issues groups         Religious groups         School spirit organizations         Student government         Student publications (newspaper, yearbook)

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