Salutation:

First Name:

Last Name:

Student ID (if known):

E-mail:

Telephone:

Address:

City:

ZIP Code:

State:

Major or planned major:

Student Status:

Housing:

To which program option do you wish to apply?

Full Kathwari Program (open to first-year students and first semester sophomores) Associate Kathwari Honors Program (the one-year program open to juniors and seniors)

* * * *

Current university or high school grade point average

GPA

Out of (Scale)

SAT or ACT scores (for full Honors Program applicants only):

Math

Verbal

Total of Math & Verbal

Class rank

out of

students in graduating class

(if known, for full Honors Program applications only)

A list and brief description of your current and recent (within the last two years) extracurricular activities.

The names and telephone numbers or e-mail addresses of two people who can provide information about your academic preparedness and record.

1st person

First Name:

Last Name:

Telephone:

E-mail Address:

2nd Person

First Name:

Last Name:

Telephone:

E-mail Address:

A brief personal statement about your interest in becoming a member of the University Honors Program. Please describe the strengths you feel you bring to the program and what you expect to gain from being a member.