2012-13 FIRST-YEAR APPLICATION
For Spring 2013 or Fall 2013 Enrollment
A P P L IC A NT
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 (only one) ____________________________ |
Former last name(s) _____________________________________________ |
Birth Date ____________________________________________________ |
US Social Security Number, if any ___________________________________ |
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Female |
Male |
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mm/dd/yyyy |
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Required for US Citizens and Permanent Residents applying for financial aid via FAFSA |
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Preferred Telephone |
Home |
Cell Home (_______) __________________________________ Cell (_______) __________________________________ |
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Area/Country/City Code |
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Area/Country/City Code |
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E-mail Address ________________________________________________ |
IM Address ____________________________________________________ |
Permanent home address __________________________________________________________________________________________________________
Number & StreetApartment #
____________________________________________________________________________________________________________________________
City/TownCounty or ParishState/ProvinceCountryZIP/Postal Code
If different from above, please give your current mailing address for all admission correspondence. |
(from ___________ to ___________) |
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(mm/dd/yyyy) |
(mm/dd/yyyy) |
Current mailing address __________________________________________________________________________________________________________
Number & StreetApartment #
____________________________________________________________________________________________________________________________
City/TownCounty or ParishState/ProvinceCountryZIP/Postal Code
If your current mailing address is a boarding school, include name of school here: _________________________________________________________________
F UT URE PL ANS
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 ______________________________________________________ |
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mm/dd/yyyy |
Entry Term: Fall (Jul-Dec)Spring (Jan-Jun)
Decision Plan___________________________________________________
Academic Interests _____________________________________________
____________________________________________________________
____________________________________________________________
Career Interest_________________________________________________
Do you intend to apply for need-based financial aid? |
Yes |
No |
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? ______________________________
What is the highest degree you intend to earn? _________________________
Citizenship Status ______________________________________________
Non-US Citizenship(s) ____________________________________________
_____________________________________________________________
_____________________________________________________________
Birthplace ________________________________________________________
City/TownState/ProvinceCountry
Years lived in the US? ____________ Years lived outside the US? ____________
Language Proficiency (Check all that apply.)
S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)
S R W F H
_______________________________________________
_______________________________________________
_______________________________________________
Optional The items with a gray background are optional. No information you provide will be used in a discriminatory manner.
Religious Preference _______________________________________________
US Armed Services veteran status _____________________________________
1. Are you Hispanic/Latino? |
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Yes, Hispanic or Latino (including Spain) |
No If yes, please describe your background. |
____________________________________________________________
2.Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more and describe your background.)
American Indian or Alaska Native (including all Original Peoples of the Americas)
Are you Enrolled? Yes No If yes, please enter Tribal Enrollment Number________________
____________________________________________________________
Asian (including Indian subcontinent and Philippines)
____________________________________________________________
Black or African American (including Africa and Caribbean)
____________________________________________________________
Native Hawaiian or Other Pacific Islander (Original Peoples)
____________________________________________________________
White (including Middle Eastern)
___________________________________________________________
© 2012 The Common Application, Inc. |
AP-1 / 2 0 1 2 - 1 3 |
E D U C AT IO N
Secondary Schools
Most recent secondary school attended ______________________________________________________________________________________________
Entry Date _________________ Graduation Date |
_________________ School Type: |
Public |
Charter |
Independent |
Religious |
Home School |
mm/yyyy |
mm/dd/yyyy |
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Address ________________________________________________________________________________ CEEB/ACT Code ___________________________
Number & Street
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City/TownState/ProvinceCountryZIP/Postal Code
Counselor’s Name __________________________________________________________ Counselor’s Title _______________________________________
E-mail _____________________________________ Telephone (_______) ______________________ Fax (_______) ________________________________
Area/Country/City Code |
Number |
Ext. |
Area/Country/City Code |
Number |
List all other secondary schools you have attended since 9th grade, including academic summer schools or enrichment programs hosted on a secondary school campus:
School Name & CEEB/ACT Code |
Location (City, State/Province, ZIP/Postal Code, Country) |
Dates Attended (mm/yyyy) |
_____________________________________________ |
_______________________________________________________ ____________________ |
_____________________________________________ |
_______________________________________________________ ____________________ |
_____________________________________________ |
_______________________________________________________ ____________________ |
Please list any community program/organization that has provided free assistance with your application process:____________________________________________
If your education was or will be interrupted, please indicate so here and provide details in the Additional Information section: ___________________________________
Colleges & Universities List all college/university affiliated courses you have taken since 9th grade and mark all that apply: taught on college campus (CO); taught on high school campus, excluding AP/IB (HS); taught online (ON); college credit awarded (CR); transcript available (TR); degree candidate (DC).
College/University Name & CEEB/ACT Code |
Location (City, State/Province, ZIP/Postal Code, Country) |
CO HS ON CR TR DC |
Dates Attended |
Degree Earned |
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mm/yyyy – mm/yyyy |
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If you indicated that a transcript is available, please have an official copy sent to your colleges as soon as possible.
A C A DE M IC S
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.
Grades |
Class Rank _________ |
Class Size _________ Weighted? |
Yes |
No |
GPA _________ |
Scale _________ |
Weighted? |
Yes |
No |
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(if available) |
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(if available) |
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ACT |
Exam Dates: ________ |
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Best Scores: _________ |
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_________ |
______ |
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(past & future) |
mm/yyyy |
mm/yyyy |
mm/yyyy |
(so far) |
COMP |
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mm/yyyy |
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English |
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mm/yyyy |
Math |
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mm/yyyy |
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Reading |
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mm/yyyy |
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Science |
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mm/yyyy |
Writing |
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mm/yyyy |
SAT |
Exam Dates: __________ __________ |
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Best Scores: ______ |
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(past & future) |
mm/dd/yyyy |
mm/dd/yyyy |
mm/dd/yyyy |
(so far) |
Critical Reading |
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mm/dd/yyyy |
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Math |
mm/dd/yyyy |
Writing |
mm/dd/yyyy |
TOEFL/ |
Exam Dates: ________ |
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Best Score: _________ |
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IELTS |
(past & future) |
mm/yyyy |
mm/yyyy |
mm/yyyy |
(so far) |
Test |
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Score |
mm/yyyy |
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AP/IB/SAT |
Best Scores: ________ |
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Subjects |
(per subject, so far) |
mm/yyyy |
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Type & Subject |
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Score |
mm/yyyy |
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Type & Subject |
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Score |
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Type & Subject |
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Score |
mm/yyyy |
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Type & Subject |
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Type & Subject |
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Score |
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Type & Subject |
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Score |
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Type & Subject |
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Score |
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Type & Subject |
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Score |
Current Courses Please list all courses you are taking this year and indicate level (AP, IB, advanced, honors, etc.) and credit value. Indicate quarter classes taken in the same semester on the appropriate semester line.
Full Year/First Semester/First Trimester |
Second Semester/Second Trimester |
Third Trimester |
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or additional first/second term courses if more space is needed |
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© 2012 The Common Application, Inc. |
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AP-3 / 2 0 1 2 - 1 3 |
Honors Briefly list any academic distinctions or honors you have received since the 9th grade or international equivalent (e.g., National Merit, Cum Laude Society).
S(School) S/R(State or Regional) |
N(National) I(International) |
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Grade level or |
Honor |
Highest Level of |
post-graduate (PG) |
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Recognition |
9 10 11 12 PG |
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S S/R N I |
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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.
Grade level or |
Approximate |
When did you participate |
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If applicable, |
post-graduate (PG) |
time spent |
in the activity? |
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do you plan |
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Summer/ |
Positions held, honors won, letters earned, or employer |
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to participate |
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9 10 |
11 12 PG |
Hours |
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Weeks |
School |
School |
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in college? |
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per week |
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per year |
year |
Break |
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Activity |
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© 2012 The Common Application, Inc. |
AP-4 / 2 0 1 2 - 1 3 |
WR I T I NG
Please briefly elaborate on one of your extracurricular activities or work experiences in the space below.
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Please write an essay of 250 – 500 words 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. 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.
Evaluate a significant 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 significant influence on you, and describe that influence.
Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence.
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.
Additional Information Please attach a separate sheet if you wish to provide details of circumstances or qualifications not reflected in the application.
Disciplinary History
Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited
to: probation, suspension, removal, dismissal, or expulsion from the institution. |
Yes |
No |
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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.
Note: Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history.
S IGNAT UR E
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.
© 2012 The Common Application, Inc. |
AP-5 / 2 0 1 2 - 1 3 |
