2009-10 First-year Application

For Spring 2010 or Fall 2010 Enrollment

APPLIC ANT

Legal name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.

Preferred name, if not rst name (choose only one) ______________________ Former last name(s), if any _______________________________________
Birth date ____________________________________________________
> Female > Male US Social Security Number, if any ___________________________________
mm/dd/yyyy Optional, unless applying for US Federal financial aid with the FAFSA form
E-mail address ________________________________________________ IM address ____________________________________________________
Permanent home address __________________________________________________________________________________________________________
Number & Street Apartment #
____________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
Permanent home phone (_____________) _____________________________ Cell phone (_____________) ______________________________________
Area Code Area Code
If different from above, please give your current mailing address for all admission correspondence.

Current mailing address __________________________________________________________________________________________________________

Number & Street Apartment #

____________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
_____
If your current mailing address is a boarding school, include name of school here: ____________________________________________________________
Phone at current mailing address (_____________) _____________________ (from ___________ to ___________)
Area Code (mm/dd/yyyy) (mm/dd/yyyy)

FUTURE PLANS
Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college
chose not to ask that question of its applicants.

College: ________________________________________________________ Deadline: ______________________________________________________

mm/dd/yyyy

Entry Term: > Fall (Jul-Dec) > Spring (Jan-Jun) Do you intend to apply for need-based nancial aid? > Yes > No
Do you intend to apply for merit-based scholarships? > Yes > No
Decision Plan: > Regular Decision > Rolling Admission Do you intend to be a full-time student? > Yes > No
> Early Decision > Early Decision II Do you intend to enroll in a degree program your rst year? > Yes > No
> Early Action > Early Action II Do you intend to live in college housing? ______________________________
> Restrictive Early Action > Early Admission Academic Interests: _____________________________________________
juniors only
____________________________________________________________
Career Interest: ________________________________________________ ____________________________________________________________

DEMOGRAPHICS

> US citizen 1. Are you Hispanic/Latino?

> Dual US citizen > Yes, Hispanic or Latino (including Spain) > No

> US permanent resident visa (Alien registration # _____________________ ) Please describe your background ________________________________________________
> Other citizenship (Visa type ____________________________________ ) 2. Regardless of your answer to the prior question, please select one or more of the
List any non-US countries of citizenship_______________________________ following ethnicities that best describe you:
_____________________________________________________________ > American Indian or Alaska Native (including all Original Peoples of the Americas)
_____________________________________________________________ Are you Enrolled? > Yes > No If yes, please enter Tribal Enrollment Number ________________

How many years have you lived in the United States?_____________________ Please describe your background ________________________________________________

Place of birth ______________________________________________________ > Asian (including Indian subcontinent and Philippines)
City/Town State/Province Country Please describe your background ________________________________________________
First language __________________________________________________ > Black or African American (including Africa and Caribbean)
Primary language spoken at home _____________________________________ Please describe your background ________________________________________________
> Native Hawaiian or Other Pacic Islander (Original Peoples)
Optional The items with a gray background are optional. No information you
Please describe your background ________________________________________________
provide will be used in a discriminatory manner.
> White (including Middle Eastern)
Marital status: ____________________________________________________ Please describe your background ________________________________________________
US Armed Services veteran? > Yes > No

2009 The Common Application, Inc. AP-1 / 2009-1 0

 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 for demo-
graphic 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 please list 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 Additional Information
section online, or on an attached sheet if applying via mail.

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
Parent 1: > Mother > Father > Unknown Parent 2: > Mother > Father > Unknown
Is Parent 1 living? > Yes > No (Date deceased ____________________) Is Parent 2 living? > Yes > No (Date deceased ____________________)
mm/yyyy mm/yyyy

____________________________________________________________ ____________________________________________________________
Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.) Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)

Country of birth ________________________________________________ Country of birth ________________________________________________

Home address if different from yours Home address if different from yours

____________________________________________________________ ____________________________________________________________

____________________________________________________________ ____________________________________________________________

Home phone (_______) __________________________________________ Home phone (_______) __________________________________________

Area Code Area Code

E-mail _______________________________________________________ E-mail _______________________________________________________

Occupation _____________________________________________________ Occupation _____________________________________________________

Name of employer ______________________________________________ Name of employer ______________________________________________

College (if any) _________________________________________________ College (if any) _________________________________________________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Graduate school (if any) __________________________________________ Graduate school (if any) __________________________________________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Legal Guardian (if other than a parent) Siblings

Please give names and ages of your brothers or sisters. If they have attended or
Relationship to you _______________________________________________ are currently attending college, give the names of the undergraduate institution,
degree earned, and approximate dates of attendance. If more than three siblings,
____________________________________________________________ please list them in the Additional Information section online, or on an attached
Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
sheet if applying via mail.
Home address if different from yours
____________________________________________________________
____________________________________________________________ Name Age Relationship

College Attended _______________________________________________

____________________________________________________________
Degree Earned _________________________ Dates __________________
Home phone (_______) __________________________________________ or Expected yyyy-yyyy
Area Code

E-mail _______________________________________________________ ____________________________________________________________

Name Age Relationship
Occupation _____________________________________________________ College Attended _______________________________________________

Name of employer ______________________________________________ Degree Earned _________________________ Dates __________________

or Expected yyyy-yyyy
College (if any) _________________________________________________
____________________________________________________________
Degree _________________________________________ Year _________ Name Age Relationship

College Attended _______________________________________________

Graduate school (if any) __________________________________________
Degree Earned _________________________ Dates __________________
Degree _________________________________________ Year _________ yyyy-yyyy
or Expected
AP-2 / 2009-1 0 2009 The Common Application, Inc.
 AC ADEMICS

Secondary Schools
Current or most recent secondary school attended ______________________________________________________________________________________

Entry Date __________________ Graduation Date __________________ School Type > public > charter > independent > religious > home school
mm/yyyy mm/dd/yyyy
Address ________________________________________________________________________________ CEEB/ACT Code ___________________________
Number & Street
__________________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
Counselors name (Mr./Ms./Dr., etc.) ____________________________________________ Counselors Title ______________________________________

E-mail _____________________________________ Phone (_______) ______________________ Fax (_______) ________________________________

Area Code Number Ext. Area Code Number
th
List all other secondary schools, including summer schools as well as summer and other programs, you have attended, beginning with 9 grade.
School Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yyyy)
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
If you received college counseling or assistance with your application process from a community-based organization (such as Upward Bound, Questbridge, HEOP, etc.),
please specify. ___________________________________________________________________________________________________________________

If your secondary school education was or will be interrupted, check all that apply and provide details in the Additional Information section or on an attached sheet.

> did/will graduate late > did/will change secondary schools > did not/will not graduate

> did/will graduate early > did/will take time off > did/will receive GED Date: _______________ (Ofcial scores must be sent from the testing agency.)

mm/yyyy

Colleges & Universities List all colleges/universities at which you have taken courses for credit; list names of courses taken, grades earned, and credits earned in
the Additional Information section online, or on an attached sheet if applying via mail. Please have an ofcial transcript sent from each institution as soon as possible.
College/University Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Degree Candidate? Dates Attended Degree(s) Earned
Yes No (mm/yyyy)
_________________________________ ___________________________________________ > > __________________ __________________
_________________________________ ___________________________________________ > > __________________ __________________
_________________________________ ___________________________________________ > > __________________ __________________

TESTS
Be sure to note the tests required for each institution to which you are applying. The ofcial SAT, ACT, TOEFL, MELAB and/or IELTS scores from the appropriate testing
agencies should be sent as soon as possible.
ACT Tests Date taken/ English Math Reading Science Composite Writing Date taken/ English Math Reading Science Composite Writing
to be taken to be taken

SAT Reasoning Tests

Date taken/ Critical Math Writing Date taken/ Critical Math Writing Date taken/ Critical Math Writing
to be taken Reading to be taken Reading to be taken Reading

SAT Subject Tests

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

AP/IB Tests Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

Date taken/ Subject Score Date taken/ Subject Score Date taken/ Subject Score
to be taken to be taken to be taken

TOEFL/IELTS/MELAB Date taken/ Test Score Date taken/ Test Score Date taken/ Test Score
to be taken to be taken to be taken
2009 The Common Application, Inc. AP-3 / 2009-1 0
Honors Briey 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 Honor Level of Recognition
post-graduate (PG)
School State/ National Inter-
9 10 11 12 PG Regional national

> > > > > _________________________________________________________________________________ > > > >
> > > > > _________________________________________________________________________________ > > > >
> > > > > _________________________________________________________________________________ > > > >
> > > > > _________________________________________________________________________________ > > > >
> > > > > _________________________________________________________________________________ > > > >

ACTIVITIES
Extracurricular Please list your principal extracurricular, community, volunteer and family activities and hobbies in the order of their interest to you. Include
specic events and/or major accomplishments such as musical instrument played, varsity letters earned, etc. To allow us to focus on the highlights of your
activities, please complete this section even if you plan to attach a rsum.

Grade level or Approximate When did you participate

If applicable,
post-graduate (PG) time spent in the activity?
do you plan
Positions held, honors won, or letters earned
Hours Weeks School Summer
to participate
9 10 11 12 PG per week per year year
in college?

> > > > > > > ________________________________________________________________ >

Activity _________________________________________________________________________________________________________________

> > > > > > > ________________________________________________________________ >

Activity _________________________________________________________________________________________________________________

> > > > > > > ________________________________________________________________ >

Activity _________________________________________________________________________________________________________________

> > > > > > > ________________________________________________________________ >

Activity _________________________________________________________________________________________________________________

> > > > > > > ________________________________________________________________ >

Activity _______________________________________________________________________________________________________________

> > > > > > > ________________________________________________________________ >

Activity _________________________________________________________________________________________________________________

> > > > > > > ________________________________________________________________ >

Activity _________________________________________________________________________________________________________________

Work Experience Please list paid jobs you have held during the past three years (including summer employment).
School Summer Approximate dates Hours
Specic nature of work Employer year (mm/yyyy - mm/yyyy) per week

___________________________________________ ___________________________________ > > _______________ ______

___________________________________________ ___________________________________ > > _______________ ______

___________________________________________ ___________________________________ > > _______________ ______

___________________________________________ ___________________________________ > > _______________ ______

AP-4 / 2009-1 0 2009 The Common Application, Inc.

 WRITING

Short Answer Please briey elaborate on one of your extracurricular activities or work experiences in the space below or on an attached sheet (150 words or fewer).

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

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 application
before submission. Please indicate your topic by checking the appropriate box. This personal essay helps us become acquainted with you as a person and
student, 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 signicant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.
>  Discuss some issue of personal, local, national, or international concern and its importance to you.
> Indicate a person who has had a signicant inuence on you, and describe that inuence.
>
Describe a character in ction, a historical gure, or a creative work (as in art, music, science, etc.) that has had an inuence on you, and explain that inuence.
>  A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an
experience that illustrates what you would bring to the diversity in a college community, or an encounter that demonstrated the importance of diversity to you.
>  Topic of your choice.

Disciplinary History
/ Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from 9th grade (or the international equivalent)
forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from
the institution? > Yes > No
0 Have you ever been convicted of a misdemeanor, felony, or other crime? > Yes > No
If you answered yes to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and
reects on what you learned from the experience.

Additional Information If there is any additional information youd like to provide regarding special circumstances, additional qualications, etc., please do so in the
space below or on an attached sheet.

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

SIGNATURE
Application Fee Payment If this college requires an application fee, how will you be paying it?
> Online Payment > Will Mail Payment > Online Fee Waiver Request > Will Mail Fee Waiver Request
Required Signature
> I certify that all information submitted in the admission processincluding the application, the personal essay, any supplements, and any other supporting
materialsis my own work, factually true, and honestly presented. I authorize all schools attended to release all requested records covered under the FERPA act,
and authorize review of my application for the admission program indicated on this form. I understand that I may be subject to a range of possible disciplinary
actions, including admission revocation or expulsion, should the information Ive certied be false.
> I acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditional,
pending receipt of nal transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school. I
also afrm that I will send an enrollment deposit (or the equivalent) to only one institution; sending multiple deposits (or the equivalent) may result in the withdrawal
of my admission offers from all institutions. [Note: students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted
from the waitlist, provided that they inform the rst institution that they will no longer be enrolling.]

Signature _______________________________________________________________________________________________ Date ___________________

mm/dd/yyyy

The Common Application, Inc., and its member institutions are committed to fulfilling their mission without discrimination on the basis of race, color,
national origin, religion, age, sex, gender, sexual orientation, disability, or veteran status.

2009 The Common Application, Inc. AP-5 / 2009-1 0