Please do not use initials or abbreviations. Please read general instructions before beginning. Date Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2008 2009 2010 2011 2012 General Information Last Name First Name Middle Name Parents or Guardian Permanent Mailing Address City State ZIP Telephone E-mail Education High School Cumulative GPA ACT Score Proposed College Major Plans for enrollment in a college or technical school Have you made application to the school? Yes No Were you accepted? Yes No Summary of your educational and career plans Employment History Skip this section if you are attaching the information with your application. Employer 1 Name of Employer Job Title/Type of Work Dates Worked Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Employer 2 Name of Employer Job Title/Type of Work Dates Worked Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Employer 3 Name of Employer Job Title/Type of Work Dates Worked Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Additional Comments about Employment Extra Curricular Skip this section if you are attaching the information with your application. Please list all extra curricular activities you have participated in. Activity 1 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 2 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 3 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 4 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 5 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 6 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 7 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 8 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 9 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Activity 10 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Additional Comments about Extracurricular Activities Leadership/Volunteer Experience Skip this section if you are attaching the information with your application. Please list any positions of leadership or volunteer service activities you have engaged in. Experience 1 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Experience 2 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Experience 3 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Experience 4 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Experience 5 Dates Participated In Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 to Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Additional Comments about Leadership/Volunteer Experiences Honors/Awards Skip this section if you are attaching the information with your application. Please state any honors or awards you have received. Honor 1 Date Received Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Honor 2 Date Received Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Honor 3 Date Received Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Honor 4 Date Received Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000
Honor 5 Date Received Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 Additional Comments about Honors/Awards Received Essay Please supply an essay of 300 words or less about why you are pursuing an education of in your chosen trade or technological field of study and describe your educational and career plans.
