2010-11 TRANSFEr Application

For Spring 2011 or Fall 2011 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 first name (choose only one) ______________________ Former last name(s), if any _______________________________________

Female
Male
Birth date ____________________________________________________ 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 County or Parish State/Province Country ZIP/Postal Code

Preferred Telephone
Home
Cell Home (_______) __________________________________ Cell (_______) __________________________________
Area/Country/City Code Area/Country/City Code
If different from above, please give your current mailing address for all admission correspondence.

Current mailing address (from ___________ to ___________) ____________________________________________________________________________

(mm/dd/yyyy) (mm/dd/yyyy) Number and Street Apartment #

____________________________________________________________________________________________________________________________
City/Town County or Parish State/Province Country ZIP/Postal Code

If your current mailing address is a college or university, include name of school here: _____________________________________________________________

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 financial aid?
Yes
No
Academic Interests _____________________________________________ Do you intend to apply for merit-based scholarships?
Yes
No
Do you intend to be a full-time student?
Yes
No
____________________________________________________________
Do you intend to enroll in a degree program your first year?
Yes
No
____________________________________________________________ Do you intend to live in college housing? ______________________________
Career Interest _________________________________________________ What is the highest degree you intend to earn? _________________________

DEMOGRAPHICS
Citizenship Status ______________________________________________ 1. Are you Hispanic/Latino?
Non-US Citizenship ______________________________________________
Yes, Hispanic or Latino (including Spain)
No
_____________________________________________________________ _________________________________________________________________________
_____________________________________________________________ 2. Regardless of your answer to the prior question, please indicate how you identify
yourself. (Check all that apply.)
Years lived in the US? ____________________________________________

American Indian or Alaska Native (including all Original Peoples of the Americas)
Birthplace ________________________________________________________
City/Town State/Province Country Are you Enrolled?
Yes
No If yes, please enter Tribal Enrollment Number________________

First Language _________________________________________________ _________________________________________________________________________

Primary language spoken at home _____________________________________
Asian (including Indian subcontinent and Philippines)
Are you proficient in any other languages? _______________________________ _________________________________________________________________________

_________________________________________________________________
Black or African American (including Africa and Caribbean)

_________________________________________________________________________
Optional The items with a gray background are optional. No information you
provide will be used in a discriminatory manner.
Native Hawaiian or Other Pacific Islander (Original Peoples)
Marital Status ____________________________________________________ _________________________________________________________________________
Religious Preference _______________________________________________
White (including Middle Eastern)
US Armed Services veteran?
Yes
No _________________________________________________________________________

© 2010 The Common Application, Inc. AP-1 / 2010-11

 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

____________________________________________________________ ____________________________________________________________

____________________________________________________________ ____________________________________________________________
Preferred Telephone:
Home
Cell
Work Preferred Telephone:
Home
Cell
Work
(_______) ____________________________________________________ (_______) ____________________________________________________
Area/Country/City Code Area/Country/City Code

E-mail _______________________________________________________ E-mail _______________________________________________________

Occupation _____________________________________________________ Occupation _____________________________________________________

Employer _____________________________________________________ Employer _____________________________________________________

College (if any) ___________________________________ CEEB ________ College (if any) ___________________________________ CEEB ________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Graduate School (if any) ____________________________ CEEB ________ Graduate School (if any) ____________________________ CEEB ________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Legal Guardian (if other than a parent) Siblings

Please give names and ages of your brothers or sisters. If they are enrolled in
Relationship to you _______________________________________________ grades K-12 (or international equivalent), list their grade levels. If they have
attended or are currently attending college, give the names of the undergraduate
____________________________________________________________ institution, degree earned, and approximate dates of attendance. If more than
Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
three siblings, please list them in the Additional Information section.
Home address if different from yours
____________________________________________________________
____________________________________________________________ Name Age & Grade Relationship

____________________________________________________________ College Attended ___________________________________ CEEB _______

Preferred Telephone:
Home
Cell
Work
Degree earned _________________________ Dates __________________
or expected mm/yyyy – mm/yyyy
(_______) ____________________________________________________
Area/Country/City Code
____________________________________________________________
E-mail _______________________________________________________ Name Age & Grade Relationship

College Attended ___________________________________ CEEB _______

Occupation _____________________________________________________

Employer _____________________________________________________ Degree earned _________________________ Dates __________________

or expected mm/yyyy – mm/yyyy
College (if any) ___________________________________ CEEB ________
____________________________________________________________
Name Age & Grade Relationship
Degree _________________________________________ Year _________
College Attended ___________________________________ CEEB _______
Graduate School (if any) ____________________________ CEEB ________
Degree earned _________________________ Dates __________________
Degree _________________________________________ Year _________ or expected mm/yyyy – mm/yyyy
© 2010 The Common Application, Inc. AP-2 / 2010-11
 EDUC ATION
Colleges & Universities Are you currently enrolled in college?
Yes
No
Current or most recent college or university attended_____________________________________________________________________________________
Entry Date __________________ Exit Date __________________ School Type
Public
Independent This is a
2-year
4-year institution
mm/yyyy mm/yyyy
Address ________________________________________________________________________________ CEEB/ACT code ___________________________
Number & Street
__________________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
Advisor’s name (Mr./Ms./Dr., etc.) ______________________________________________ Advisor’s title __________________________________________
E-mail __________________________________ Telephone (_______) ______________________ Fax (_______) _________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number
List all other colleges or universities, including summer schools as well as summer and other programs, you have attended, beginning with your first year of college.
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)
_________________________________ ___________________________________________

__________________ __________________
_________________________________ ___________________________________________

__________________ __________________
_________________________________ ___________________________________________

__________________ __________________
Do you expect to earn a degree prior to enrolling at the college to which you are applying?
Yes
No If so, what type of degree? _________________________
Are you a member of Phi Theta Kappa?
Yes
No
Secondary Schools
List all secondary schools you have attended. Please have a School Report form, Official Transcript, and School Profile sent from each institution as soon as possible.
Name of School & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yyyy)
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
Secondary School Graduate Date __________________
mm/dd/yyyy
Please list any community program/organization that has provided free assistance with your application process: ______________________________________________
If your education was interrupted, please indicate so here and provide details in the Additional Information section:___________________________________________

AC ADEMICS
The self-reported information in this section is not intended to take the place of your official records. Please note the requirements of each institution to which you are
applying and arrange for official transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where “Best Scores” are
requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates.
Secondary
School Class Rank _________ Class Size _________ Weighted?
Yes
No GPA _________ Scale _________ Weighted?
Yes
No
Grades (if available) (if available)

ACT Exam Dates: ________ ________ ________ Best Scores: _________ ______ _________ ______ _________ ______
(past & future) mm/yyyy mm/yyyy mm/yyyy (so far) COMP mm/yyyy English mm/yyyy Math mm/yyyy
_________ ______ _________ ______ _________ ______
Reading mm/yyyy Science mm/yyyy Writing mm/yyyy

SAT Exam Dates: ________ ________ ________ Best Scores: _________ ______ _________ ______ _________ ______
(past & future) mm/yyyy mm/yyyy mm/yyyy (so far) Critical Reading mm/yyyy Math mm/yyyy Writing mm/yyyy

TOEFL/ Exam Dates: ________ ________ ________ Best Score: _________ ______ ______
IELTS (past & future) mm/yyyy mm/yyyy mm/yyyy (so far) Test Score mm/yyyy

AP/IB/SAT Best Scores: ________ __________________________________ _____ ________ __________________________________ _____

Subjects (per subject, so far) mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score

________ __________________________________ _____ ________ __________________________________ _____

mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score

________ __________________________________ _____ ________ __________________________________ _____

mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score

________ __________________________________ _____ ________ __________________________________ _____

mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score

Current Courses Please indicate title, level (100-level, 200-level, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken in the
same semester on the appropriate semester line. If you’re not currently enrolled in college, please list the classes you took during 12th grade.
First Semester/Trimester Second Semester/Trimester Third Trimester
or additional first/second term courses if more space is needed
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
© 2010 The Common Application, Inc. AP-3 / 2010-11
Honors Briefly list any academic distinctions or honors you have received since the 11th grade or international equivalent (e.g. National Merit, Cum Laude Society).
Grade level Honor Level of Recognition
School State/ National Inter-
11 12 FY SO JR Regional national





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_________________________________________________________________________________

EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE

Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and
paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (specific events, varsity letter, musical
instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a résumé.
Approximate When did you participate If applicable,
Grade level time spent in the activity? do you plan
Summer/ Positions held, honors won, letters earned, or employer
to participate
11 12 FY SO JR Hours Weeks School School
per week per year year Break in college?

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

© 2010 The Common Application, Inc. AP-4 / 2010-11

 WRITING
Short Answer Please briefly 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 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.

Please provide a statement (250 words minimum) that addresses your reasons for transferring and the objectives you hope to achieve, and attach it to your
application before submission. NOTE: Your Common Application essay should be the same for all colleges. Do not customize it in any way for individual colleges.
Colleges that want customized essay responses will ask for them on a supplement form.

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

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________

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
 Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime?
Yes
No
[Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed,
annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]
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
reflects on what you learned from the experience.

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 process-including the application, the personal essay, any supplements, and any other supporting
materials-is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying
and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or
revocation of course credit, grades, and degree should the information I have certified 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 final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.
 I affirm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or 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 first institution that they will no longer be enrolling.]

Signature _______________________________________________________________________________________________ Date ___________________

mm/dd/yyyy

Common Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex,
age, marital status, parental status, physical disability, learning disability, political affiliation, veteran status, or sexual orientation.

© 2010 The Common Application, Inc. AP-5 / 2010-11