NAME ____________________________________   SSN #: ____________________   

CAMPUS ADDRESS: __________________________   SCHOOL/CLASS: ____________

                __________________________  

E-MAIL:         __________________________   CAMPUS PHONE:  _____________                              

PERMANENT ADDRESS: _________________________

                   _________________________	

PERMANENT PHONE:   __________________________


MAJOR (S), MINORS:  ____________________________________________________

IF ANY, GRADUATE SCHOOL OR DEPT. TO WHICH YOU ARE APPLYING: ________________

DEGREE(S) SOUGHT: _____________________________________________________


SAT SCORES: Verbal: ______________  Math: _________________
CURRENT GPA (cum.):  _____________  GPA in major field : ____________ 

CURRENT SEMESTER SCHEDULE (course title, #, and professor)












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