Macaulay H nors College o The City University of New York ... · OSIS Nigeria (113) You Mother...
Transcript of Macaulay H nors College o The City University of New York ... · OSIS Nigeria (113) You Mother...
Sincerely,
Ann KirschnerUniversity Dean
Macaulay H nors College The City University of New York 35 West 67
o
thStreet New York, NY 10023
Please download and print your Application Summary Package, which includes your applicationcontrol number, a summary of your Admission Application and important forms that must be usedwhen sending paper transcripts, payment and/or other supporting documents by mail.
Thank you for applying to Macaulay Honors College at CUNY.
September 2, 2010
Our application is designed to provide information about your preparation for our rigorous and excitingcourse of study. We look forward to learning more about you!
Macaulay offers an exceptional education for future leaders of New York City. Through unique,individualized advising, each Macaulay student develops a coordinated program that integratesacademic preparation, independent research, global learning, community engagement, closefaculty-student collaboration, and internships to explore and prepare for your future career aspirations.
Dear Mr. Dewey,
You can review the status of your application at any time at www.cuny.edu/status.
SAMPLE
Applicant's Last Name
Applicant's First Name
(Any prior last name used)
M I
Length of time at t he above address Length of time in N.Y.C.
Years / Months
Length of time in N.Y.S.
Mailing Address
Social Security Number
** If you do not have a SocialSecurity Number, check here.
Day Telephone Number E-mail Address
(if di�erent from above, or local address for in ternational applicants)
Please read the applic ation booklet before completing this application.
Please print all information in BLUE OR BLACK INK ( bold) and sign the form.
Applicant's Address
City State Zip Code
Years / Months Years / Months
Evening Telephone Number
City State Zip CodeCountry
1 2
3
4
4a 4b 4c
5
6 7 7a
Choice of College and Curriculum: Before entering your co llege choice, please refer to theinstructions. Indicate your choice in the boxes printed below, following the directions given.
Code College Name
CITY UNIVERSITY COLLEGE CHOICE
-1-
_
_
Apt. #
Apt. #
8b
8aIntended Major8
CONTACT INFORMATION
MaleFemale
** Record your social security number in the appropriate space. You are required to furnish your Social Security Account Number (SSAN). Your SSAN will beused as a unique identi�er for veri�cation of your identity, records maintenance, �nancial aid, and other purposes where it is necessary or practical to identifyyou by number. The authority for requiring disclosure of your SSAN is based upon Section 7(a )(2)(b) of the Federal Privacy Act. In addition, your SSAN shouldappear on all checks, money orders, applications, and documents sent to UAPC. If you do not have a social security number, a un ique identifying number willbe assigned to your �le. This will in no way a�ect your admission status.
Su�x (Jr., Sr.)
APPLICATION FOR ADMISSION TO THE CUNY MACAULAYHONORS COLLEGE: PERSONAL AND HIGH SCHOOL DATA FORM
Date of Birth
Month YearDay
I am considering preparing to become a teacher in:Early Childhood or Elem entary School
Middle School or Hig h School
AN
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0
0
0
0
0
0
0
0
0
*** Student Copy ***
Hunter College
18/00
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7
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7
A
3
H
5
C
9
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0
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000
7330
YN
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LOCNIL00
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3650
Y
9
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Questions 9-10: Citizenship status and alienage are used to determine if any other educational documents ar e needed to evaluate your application and to beginthe visa process for temporary visa applicants. They are also used to determine your eligib ility for available �nancial aid programs.
Are you a U.S. citizen? If no, please state:
Country of Birth
Country of Citizenship
Immigration Status:
-2-
9 10
Yes No
China: Mainland (032)
China: Taiwan (148) Hong Kong (170)
Korea (083)India (070) Vietnam (178)
The Philippines (121)
Bangladesh (012)
Israel (075)
Mexico (100)
Peru (120)
Colombia (033)
Cuba (038)
Dominican Republic (045)
Ecuador (046)
Guyana (065)
Haiti (066)
Jamaica (077)
Puerto Rico (185)
Trinidad (153)
England, Scotl and, or Wales (160)
Germany (056)
Barbados (013)
Greece (060) Ireland (074)
Italy (076)
Poland (122)
Russia (158)
Ukraine (223)
Other - specify
Born in the United States, excludingPuerto Rico or U.S. Territories
Born in Puerto Rico or U.S. Territories
Born outside of the United States
11
12
13
Yes No
Do you speak a language other than English at home? If yes, with which language do you feel more comfortable?
English Language other thanEnglish
Equally comfortablewith both
14
Your native language Other languages spoken14a 14b
Father's full name
Last Name First Name MI
15
Father living? Yes No
Citizen of U.S.? Yes No
Father's resi dence
City State Country
Father's occ upation
16
17
16a
Mother's full name
Last Name First Name MI
18
Mother living? Yes No
Citizen of U.S.? Yes No
Mother's resi dence
City State Country
Mother's occ upation
19
20
19a
Alien Registration (I551) Card #
Other
Date Obtained MM/YY Expiration Date MM/YYPlease Specify Type of Visa
U.S. permanent residentDate Obtained MM/YY
TemporaryVisa
Explain
AUTOBIOGRAPHICAL DATA
OSIS
Nigeria (113)
You Mother Father
Black or African A merican
Native Hawaiian or Other Paci�c Islander
AsianAmerican Indian or Alaska Native
Are you Hispanic / Latin o? Yes No
*** Student Copy ***
Where were you and each of your parents born?Check one in each column.
Response to Questions 11 through 13 is voluntary, and the information will be kept confidential. Refusal to provide this information will not affect your application.
✔
Indicate your race by selecting one or more options.
White
From what country or part of the world did you or your family originally come? (Check the box next to the name of the country or part of the worldwith which you most identify.)
SAMPLE
B. Current courses: If you are attending high school, list your senior year courses. Indicate any honors/college level/enrichment courses.
C. List any summer institutes or special programs you have attended during high school.
D. List any paid or volunteer jobs you have held during high school.
E. List any special talents/interests and honors or awards received.
F. List extracurricular activities (sports, clubs, band, yearbook, etc.) and community/volunteer activities. Include dates of participation and o�ces held.
-3-
Employer Name Type of Work Dates of Employment Hours Per Week
Activity Name Dates of Participation Offices Held
A. ESSAY:
21 Please answer the following questions. Use a separate sheet of paper, if necessary.
*** Student Copy ***
See attached.
SAMPLE
HIGH SCHOOL/SECONDARY SCHOOL INFORMATION
Name of High School
Date of actual or anticipated H.S. graduation
Month Year
H.S. Address
City State
22
22a
FOR UAPC USE ONLY
Are you a dependent of a veteran of the U.S. Armed Forces?
Yes No
23
-4-
ALL APPLICANTS MUST SIGN HERE
I understand that with this application, I am applying for the Honors College at The City University of New York.
I hereby certify that all the information in this application is accurate and complete. I realize that failure to �le the appropriate application may a�ect myadmission status. I understand that all the information contained in this application will be treated con�dentially and will be used for institutional purposesonly.
Applicant's Signature: Date:
24
NOTE: The City University of New York does not discriminate on the basis of age, sex, race, creed, color, national origin, physical or mental disability, sexualorientation, marital status, alienage or citizenship status, or veteran's status.
S R VTRAN ESL CSBATESTOEFLMV
University Application Processing CenterP.O. BOX 359021Brooklyn, NY 11235-0001
Send all completed application materials, along with theself-addressed postcard, in the envelope provided .(see inside back cover pocket)
If you are applying to the articulated BA/MD medical program at Brooklyn College, please contact the admissions o�ce at (718) 951-5001 for asupplemental application.
To ensure that your application is processed in a timely manner:
· Use paper clips, not staples, to attach documents to your application form.
· Print clearly on all application forms.
· Where possible, submit all documents at the same time. CUNY cannot begin processing your application until we have received every component, including fees and transcripts.
· Submit only one application.
WMV
*** Student Copy ***
1102
JOHN DEWEY HIGH SCH
NYBROOKLYN
60 ✔
SAMPLE
Recommender Nam
ge Application
2.
1.
Mrs. Sharon Doe
Mr. John Doe
CUNY Macaulay Honors Colle
StatusTypeDate SentE-mail Addresse
Recommendations
09/02/2010
09/02/2010
Incomplete
Incomplete
SAMPLE
CUNY Macaulay Honors College Application Essay
Applicant Name: Date Submitted:
Control Number:
Michael Dewey September 02, 2010
Test
Page : 1
Evaluate a significant risk you have taken or ethical dilemma you have faced and discuss itsimpact on you. (500 words or less)
W0000000000
SAMPLE
CUNY Macaulay Honors College Application Essay
Applicant Name: Date Submitted:
Control Number:
Michael Dewey September 02, 2010
Test
Page : 1
Discuss some issue of local, national, or international concern and its importance to you. (500words or less)
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SAMPLE
High School Transcript Request Form
Instructions: Print this form and submit to your school counselor or guidance office sothat your transcript may be forwarded to CUNY/UAPC.
Student Information
Graduation Date:
High School Information
To Whom It May Concern: I am applying to The City University of New York. Please send my high school transcript, including SAT or ACT scores (if applicable) to the following address:
CUNY/UAPC
Please do not include a copy of the application with this document.
Yours truly,
*HTRN*
Brooklyn, New York 11235-0001P.O. Box 359021
September 2, 2010
Mac
aula
y H
onor
s Col
lege
2011
Brooklyn, NY 11223
Macaulay Honors College Admission
50 Av XJohn Dewey High Sch
Michael Dewey
Michael Dewey
(H)W0000000000
SAMPLE
Instructions: Print and mail this return receipt along with your non-refundablecheck, money order, or CUNY Fee Waiver payable to CUNY/UAPC in a sealed envelopeto the following address:
CUNY/UAPC
Please do not include a copy of your application with this document.
Student Information
Graduation Date:
Check the method of payment included with this receipt.
Personal check in the amount of _____________
Money order in the amount of _____________
Official CUNY Fee Waiver # _____________
Application Fee Return Receipt
*FEES*
Brooklyn, New York 11235-0001P.O. Box 359021
September 2, 2010
Mac
aula
y H
onor
s Col
lege
2011
Macaulay Honors College Admission
Michael Dewey
(H)W0000000000
$65.00
SAMPLE
Document Return Receipt
Instructions: Print and mail this receipt along with any supporting documents required tocomplete your application. When possible, send all documents together in a singleenvelope. Please remember to affix proper postage. Mail your materials in a sealedenvelope to the following address:
CUNY/UAPC
Please do not include a copy of your application with this document.
Student Information
Graduation Date:
Application Control Number:
Check all the items included with this receipt.
Students Educated Within the United States
GED (Test Scores & Diploma)
SAT or ACT Score Report
Other ___________________________
Students Educated Outside the United States
Secondary School Transcript(s)
TOEFL Score Report
Translation(s) of Academic Record(s)
Other ___________________________
Brooklyn, New York 11235-0001P.O. Box 359021
September 2, 2010
Mac
aula
y H
onor
s Col
lege
2011
Macaulay Honors College Admission
Michael Dewey
(H)W0000000000
SAMPLE