Sample Common Application 2013
The Common Application
The Common Application - 2012-13 First-year Application
For Spring 2013 or Fall 2013 Enrollment

APPLICANT

Legal Name Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.

Preferred name, if not ﬁrst name (only one)
Former last name(s)

Birth Date (mm/dd/yyyy)

US Social Security Number, if any
Required for US Citizens and Permanent Residents applying for financial aid via FAFSA

Preferred Telephone
Home
Cell Home

E-mail Address
IM Address
Permanent home address

Number & Street Apartment #

City/Town County or Parish State/Province Country ZIP/Postal Code
If different from above, please give your current mailing address for all admission correspondence. (from ___________ to ___________) (mm/dd/yyyy)

Current mailing address
Number & Street Apartment #
City/Town County or Parish State/Province Country ZIP/Postal Code

If your current mailing address is a boarding school, include name of school here:

FUTURE PLANS
Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants.

College
Deadline (mm/dd/yyyy)

Entry Term: Fall (Jul-Dec) Spring (Jan-Jun)

Decision Plan

Academic Interests

Career Interest
Do you intend to apply for need-based ﬁnancial aid? Yes No

Do you intend to apply for merit-based scholarships? Yes No

Do you intend to be a full-time student? Yes No

Do you intend to enroll in a degree program your ﬁrst year? Yes No

Do you intend to live in college housing?

What is the highest degree you intend to earn?

DEMOGRAPHICS

Female Male

Citizenship Status

Non-US Citizenship(s)

Birthplace (City/Town State/Province Country)

Years lived in the US?
Years lived outside the US?

Language Proficiency (Check all that apply.)
S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home) SRWFH
Optional
The items with a gray background are optional. No information you provide will be used in a discriminatory manner.

Religious Preference

US Armed Services veteran status

1. Are you Hispanic/Latino?
Yes, Hispanic or Latino (including Spain)
No If yes, please describe your background.

2. Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more and describe your background.)
American Indian or Alaska Native (including all Original Peoples of the Americas)
Are you Enrolled? Yes No If yes, please enter Tribal Enrollment Number

Asian (including Indian subcontinent and Philippines)
Black or African American (including Africa and Caribbean)
Native Hawaiian or Other Paciﬁc Islander (Original Peoples)
White (including Middle Eastern)

FAMILY

Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information for demographic purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then please list that information below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the Additional Information section.

Household
Parents’ marital status (relative to each other):
Never Married Married Civil Union/Domestic Partners Widowed Separated Divorced (date _________ (mm/yyyy))

With whom do you make your permanent home?
Parent 1 Parent 2 Both Legal Guardian Ward of the Court/State Other
If you have children, how many? _________

Parent 1

Mother Father Unknown
Is Parent 1 living? Yes No (Date Deceased ____________________(mm/yyyy))

Last/Family/Sur First/Given Middle
Former last name(s)

Country of birth

Home address if different from yours

Preferred Telephone: Home Cell Work

E-mail

Occupation

Employer

College (if any)
CEEB
Degree
Year
Graduate School (if any)
CEEB
Degree
Year

Parent 2

Mother Father Unknown
Is Parent 1 living? Yes No (Date Deceased ____________________(mm/yyyy))

Last/Family/Sur First/Given Middle
Former last name(s)

Country of birth

Home address if different from yours

Preferred Telephone: Home Cell Work

E-mail

Occupation

Employer

College (if any)
CEEB
Degree
Year
Graduate School (if any)
CEEB
Degree
Year

Legal Guardian (if other than a parent)

Relationship to you

Last/Family/Sur First/Given Middle

Country of birth

Home address if different from yours

Preferred Telephone: Home Cell Work

E-mail

Occupation

Employer

College (if any)
CEEB
Degree
Year
Graduate School (if any)
CEEB
Degree
Year

Siblings

Please give names and ages of your brothers or sisters. If they are enrolled in grades K-12 (or international equivalent), list their grade levels. If they have attended or are currently attending college, give the names of the undergraduate institution, degree earned, and approximate dates of attendance. If more than three siblings, please list them in the Additional Information section.

Name, Age & Grade, Relationship
College Attended
CEEB
Degree earned
Dates or expected mm/yyyy – mm/yyyy

EDUCATION

Secondary Schools

Most recent secondary school attended
Entry Date
Graduation Date (mm/yyyy-mm/dd/yyyy)
School Type: Public Charter Independent Religious Home School
Address
CEEB/ACT Code
Number & Street
City/Town State/Province Country ZIP/Postal Code
Counselor’s Name
Counselor’s Title
E-mail
Telephone (Ext.)
Fax

List all other secondary schools you have attended since 9th grade, including academic summer schools or enrichment programs hosted on a secondary school campus:
School Name, CEEB/ACT Code, Location (City, State/Province, ZIP/Postal Code, Country), Dates Attended (mm/yyyy)

Please list any community program/organization that has provided free assistance with your application process

If your education was or will be interrupted, please indicate so here and provide details in the Additional Information section:

Colleges & Universities

List all college/university affiliated courses you have taken since 9th grade and mark all that apply:
taught on college campus (CO);
taught on high school campus, excluding AP/IB (HS);
taught online (ON);
college credit awarded (CR);
transcript available (TR);
degree candidate (DC).

College/University Name, CEEB/ACT Code, Location (City, State/Province, ZIP/Postal Code, Country), CO HS ON CR TR DC, Dates Attended (mm/yyyy – mm/yyyy), Degree Earned

If you indicated that a transcript is available, please have an ofﬁcial copy sent to your colleges as soon as possible.

ACADEMICS

The self-reported information in this section is not intended to take the place of your ofﬁcial records. Please note the requirements of each institution to which you are applying and arrange for ofﬁcial transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where “Best Scores” are requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates.

Grades
Class Rank
Class Size
Weighted? Yes No
GPA
Scale
Weighted? Yes No

ACT
Exam Dates (past and future, mm/dd/yyyy):
Best Scores (so far, mm/dd/yyyy): COMP English Math Reading Science Writing

SAT
Exam Dates (past and future, mm/dd/yyyy):
Best Scores (so far, mm/dd/yyyy): Critical Reading Math Writing

TOEFL/IELTS
Exam Dates (past and future, mm/yyyy):
Best Score (so far): Test, Score, mm/yyyy

AP/IB/SAT Subjects
Best Scores: (per subject, so far) mm/yyyy, Type, Subject Score

Current Courses
Please list all courses you are taking this year and indicate level (AP, IB, advanced, honors, etc.) and credit value. Indicate quarter classes taken in the same semester on the appropriate semester line.

Full Year/First Semester/First Trimester

Second Semester/Second Trimester

Third Trimester or additional first/second term courses if more space is needed

Honors
Brieﬂy list any academic distinctions or honors you have received since the 9th grade or international equivalent (e.g., National Merit, Cum Laude Society). (S(School) S/R(State or Regional) N(National) I(International))
Grade level or post-graduate (PG)
Honor
Highest Level of Recognition (S S/R N I)

EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE

Extracurricular
Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (speciﬁc events, varsity letter, musical instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a résumé.

Grade level or post-graduate (PG) (9 10 11 12 PG)
Approximate time spent (Hours per week/Weeks per year)
When did you participate in the activity? (School year, Summer/School Break)
Positions held, honors won, letters earned, or employer
If applicable, do you plan to participate in college?
Activity

WRITING
Please brieﬂy elaborate on one of your extracurricular activities or work experiences in the space below.

Please write an essay of 250 – 500 words on a topic of your choice or on one of the options listed below, and attach it to your application before submission. Please indicate your topic by checking the appropriate box. This personal essay helps us become acquainted with you as a person and student, apart from courses, grades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and express yourself. NOTE: Your Common Application essay should be the same for all colleges. Do not customize it in any way for individual colleges. Colleges that want customized essay responses will ask for them on a supplement form.

1. Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.
2. Discuss some issue of personal, local, national, or international concern and its importance to you.
3. Indicate a person who has had a significant influence on you, and describe that influence.
4. Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence.
5. A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an experience that illustrates what you would bring to the diversity in a college community or an encounter that demonstrated the importance of diversity to you.
6. Topic of your choice.

Additional Information
Please attach a separate sheet if you wish to provide details of circumstances or qualiﬁcations not reﬂected in the application.

Disciplinary History
1. Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution. Yes No
2. Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? Yes No
[Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept conﬁdential.]

If you answered “yes” to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reﬂects on what you learned from the experience.

Note: Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history.

SIGNATURE
Application Fee Payment
If this college requires an application fee, how will you be paying it?
Online Payment, Will Mail Payment, Online Fee Waiver Request, Will Mail Fee Waiver Request

Required Signature
I certify that all information submitted in the admission process—including the application, the personal essay, any supplements, and any other supporting materials—is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree, should the information I have certiﬁed be false.

I acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditional, pending receipt of ﬁnal transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.

I affirm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of my admission offers from all institutions. [Note: Students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted from the waitlist, provided that they inform the ﬁrst institution that they will no longer be enrolling.]

Signature
Date (mm/dd/yyyy)

Common Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex, age, marital status, parental status, physical disability, learning disability, political affiliation, veteran status, or sexual orientation.
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