Please complete and submit this application by Monday, November 4, 2013 First Name * Last Name * Student ID # Local/Cell Phone Preferred email address Classification * Freshman Sophomore Junior Senior Local Address Hometown Major 1 * Major 2 (if applicable) Minor (if applicable) Cumulative GPA * Anticipated Graduation month/year * Are you a transfer student? * Yes No Former Schools If yes, please list you former school(s). You do not need to list institutions from which you recieved college credits during high school. Please only list institutions that you attended after graduating high school Did you participate in Jumpt Start? * Yes No Which of the following places have toy lived during you time as a student? Select all that apply. * Residence Hall Sorority or Fraternity House Off-campus apartment/house At home with family List the groups and activities you have participated in during college. If applicable, list offices held and dates of involvement List you employment experience, beginning with the most recent. Include the employer names, employer locations. supervisors' names, and date of employment. List the name, position title, and email address for one faculty or staff reference List the name and e-mail address for one peer/student reference * List any special skills or interest Select your preference for a group interview day/time. If you don't have a preference, select both. You will be notified by email on Monday November 4th of your group interview time and interview location * Thursday November 7, 2013 from 3:30-5:30 p.m. Monday November 11, 2013 from 3:30-5:30 p.m. Please send to firstname.lastname@example.org, attached to an email, a one-page typed essay that describes your own experience as a first year student, and how that has influenced where you are today. Be creative! Limit your reflection to a maximum of one typed page (single-spaced, 12 fonts, Times New Roman).