Note: If you are requesting financial aid, the UGA Pre-College Financial Aid form must be submitted at the same time as your application.

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1 Application Instructions & Checklist Good Advice Early application is strongly recommended. We will begin reviewing applications in February, and will then begin accepting students on a rolling basis. We prefer that your application is complete by the time course registration begins in April, so that you can enroll in your classes as soon as registration opens. If you apply later than April, you may not get your preferred courses. Instructions 1. Complete the two-page application form completely and accurately. 2. Address each of the Short Essay topics on a separate sheet of paper. 3. Complete the Self Reported Grade section of the application. 4. Request an official sealed transcript from your school. We prefer that you include the sealed transcript with your application materials, but you may request it sent directly to the Pre-College office. See the Additional Application Materials section for more details. 5. Request recommendations from two current teachers (or one teacher and one counselor). Each of them must fill out provided form and return it as directed. See the Additional Application Materials section for more details. 6. Complete the Application Payment Form. 7. Submit the complete application and payment form by mail to: UGA Pre-College Admissions 1197 S. Lumpkin Street, Office 191 Athens, GA Applications cannot be accepted by or fax. Note: If you are requesting financial aid, the UGA Pre-College Financial Aid form must be submitted at the same time as your application. Important Admission Dates December 15 February 7 April 1 April 22 May 6 Applications are posted on the website and students may begin applying to Pre-College. The Pre-College Admissions Committee begins reviewing complete applications, and notices of admission will be sent out on February 21. After February 21, admission decisions will be made on a rolling basis and applicants will be informed of a decision within two weeks of the receipt of all application materials (see checklist below). Course enrollment begins for accepted students. Last date for receipt of all application materials from students in need of financial assistance. Last date for receipt of all application materials. Checklist Application Form is completed Short Essays are completed and included with the application form Self Reported Grades are completed and included with the application form High School Transcripts are included (sealed) or have been requested and are being sent from the school Two Teacher Recommendation Forms are included (sealed & signed) or are being sent from the teacher(s) Application Payment Form has been completed and included with the application form Financial Aid Form (if applicable) has been completed and included with the application form

2 Application for Admission Applicant Information UGA Pre-College Summer Programs 2011 Name: Home Phone: ( ) Cell Phone: ( ) Applicant s address: (required) Date of Birth: (MM/DD/YY) Gender: Male Female Citizenship: U.S. Citizen U.S. Permanent Resident - citizen of: Please check the appropriate box: If box (c) is checked, please provide: Alien Registration/Green Card (A#) number: Program Information a. I plan to live on campus in the residence hall b. I plan to live at home and commute to campus c. I plan to live with relatives/friends and commute to campus 1. A letter from your parent(s) giving you permission to stay with relatives/friends 2. Information on the relatives/friends, including names, ages, relationship to you, address and all phone numbers 3. A statement from the relatives/friends that they will be at their address the entire time of the program and that they accept responsibility for you during that time Parent/Guardian Information Full Name: Primary Phone: ( ) Alternate Phone: ( ) Relationship: Full Name: Primary Phone: ( ) Alternate Phone: ( ) Relationship:

3 Standardized Testing History Scores are self-reported - you do not need to provide official records or reports of test scores for admission to Pre-College. Have you taken the SAT? Yes No Date Taken: Critical Reading: Math: Writing: Have you taken the ACT? Yes No Date Taken: Composite: Writing: Have you taken the PSAT? Yes No Date Taken: Reading: Math: Writing: School Information Grade Entering in Fall 2011: 11 th 12 th School Name: School School City/State/Zip: Main Academic Interests: Extracurricular Activities: Check here if you have ever incurred serious disciplinary action, been suspended or have any court conviction other than parking violations. Please provide an explanation on a separate sheet of paper. Voluntary Information How did you hear about the UGA Pre-College program? (check all that apply & specify where needed) Received a postcard in the mail Parent/Family Member Friend UGA Web site from School Search engine: Ad Poster Facebook Twitter Other Ethnicity (check all that apply) African-American/Black American Indian/Alaskan Native White/Middle Eastern Native Hawaiian/Pacific Islander Asian Hispanic or Latino/a University of Georgia Honor Code and Application Validation I will be academically honest in all of my academic work and will not tolerate the academic dishonesty of others. I accept full responsibility for the information submitted on this form and understand that incorrect or incomplete information may result in the denial or revocation of my admission. I further agree that if I am accepted to the UGA Pre-College program, I will abide by the University of Georgia Honor Code, the UGA Pre-College Code of Conduct, and all UGA Pre-College policies and procedures. Student Signature Parent/Guardian Signature Date Date

4 Additional Application Materials I. Short Essays On a separate piece of paper labeled UGA Pre-College Short Essays, please address each of the following three topics in responses that are words each. Please be sure to include your full name (as listed on your application) and date of birth on each page of the attachment, as well as the essay topic with each of your responses. A. Music expresses that which cannot be put into words and cannot remain silent. Victor Hugo If someone were to look at your music collection right now, they would probably know a great deal about who you are. Individuals are drawn to music, and each song conveys something about that person. Select a musical piece to be your theme song. Tell us what it would be, and more specifically, why it represents who you are. B. Who is the most successful person in the world today and why? C. What is college for? II. Self Reported Grades As a Pre-College applicant, you are required to complete the following Self Reported Academic Record Chart. We will use this, along with your high school transcript, to review your academic performance. It is important that you complete this chart accurately and completely and list all academic grades, even if a course was repeated or taken during the summer. If you are a home-educated student attending a non-accredited institution, please indicate so here. All other applications MUST complete the chart below. I cannot self report my grades. In your high school career, how many of the following letter grades have you earned in each subject area? Ex: If you earned a B in Physical Science and a B in Biology, you will place the number 2 in the B s column of the Science row. Courses A s B s C s D s F s English Math Science Social Studies Foreign Language Other AP courses Of the grades listed above, how many were in AP courses? Please list the courses you are currently enrolled in, but have not yet completed. Course name / level Term Course name / level Term Ex: Government Honors Fall A.P. Calculus Spring III. IV. High School Transcripts As a Pre-College applicant, you are required to submit an official high school transcript. The transcript can be submitted in one of two ways: It may be returned with this application, in a sealed envelope with an administrative stamp or signature across the seal. (*Preferred method) It may be mailed or faxed directly to the UGA Pre-College Office from an official school fax line. Teacher/Counselor Recommendations use the required forms! You must submit two official Recommendation Forms, either from two current high school teachers or one current high school teacher and your current high school counselor. We prefer that the teacher return the completed form to you in a sealed envelope (with their signature over the flap) for submission with your Pre-College application. If that is not possible, please provide the recommender with a stamped envelope addressed to the Pre-College office (located on the top of each page of the application and forms).

5 Application Payment Form Applicant Information UGA Pre-College Summer Programs 2011 Name: Home Phone: ( ) Cell Phone: ( ) Applicant s address: (required) Date of Birth: (MM/DD/YY) Gender: Male Female Payment of Application Processing Fee Enclosed is the $50 payment of the nonrefundable application fee. (Application will not be considered without the fee.) Payment Type: Check* Money Order* Credit Card (please fill out information below) *Please makes checks and money orders payable to The University of Georgia Credit card payment information Card Visa MasterCard Discover American Express Card Number Expiration Date Cardholder Signature Cardholder Name (printed) Cardholder address Authorization (must be checked) I authorize The University of Georgia to charge my credit card in the amount of $50 for the nonrefundable application processing fee. I certify that all of the above information is true and complete to the best of my knowledge. Student Signature Date

6 Teacher/Counselor Recommendation Form 1 Please complete the first section below and give this form to a current teacher or counselor. This form must be submitted in one of the following ways or it will be considered invalid: In a sealed envelope with the teacher s signature over the flap, along with your Pre-College application In a sealed envelope with the teacher s signature over the flap, mailed directly to the Pre-College office Faxed to the number above from an official school fax line FOR THE STUDENT TO COMPLETE: Name: Home Phone: ( ) Date of Birth: / / Name of Recommender: Position: Subject(s) Taught: Phone: I authorize the above person to release information and provide an evaluation about any and all information from my/my child s education records; including information pertaining to my/my child s education at other institutions that I/he/she have previously attended which is a part of the record. I understand further that: (1) I have the right not to consent to the release of my education records; (2) I have a right to receive a copy of any written reference upon request; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to the above recommender, but that any such revocation shall not affect disclosures previously made by said recommender prior to his/her receipt of any such written revocation. Check one: I waive ( ), do not waive ( ) my right to see the recommendation or other information prepared pursuant to this release. Student/Parent/Guardian Signature Date: FOR THE RECOMMENDER TO COMPLETE: The above student has applied to the University of Georgia Pre-College Program. While here, he/she will experience life on a college campus, including challenging academic courses, social activities and a great deal of independence. We are interested in information that will help us evaluate this student s potential to succeed in such an environment. Feel free to use a separate sheet of paper if you need more space for comments. Please evaluate the applicant in the following areas, using his or her entire class for comparison. Academic motivation and interest Intellectual ability Emotional maturity Social interaction with peers Ability to work as part of a team Ability to work independently Ability to cope with pressure Outstanding (Top 5%) Excellent Above Average Average Below Average continued on second page

7 Please illustrate the student s motivation and work habits in the classroom. How does this student express his/her creativity and imagination? Describe any special talents or exceptional experiences you know this student to possess. Personal comments are extremely important in the selection process. We would appreciate a frank and full statement about this applicant, including an assessment of intellectual and personal qualities, an indication of any particular strengths and weaknesses, and your opinion about this student s potential to succeed in the Pre-College Program. To the best of your knowledge, has this student incurred serious or repeated disciplinary action, been suspended or left voluntarily for an extended period of time? Y N If yes, please explain. I recommend this applicant for admission to the University of Georgia Pre-College Program. For academic promise For character and personal promise Overall Not recommended Moderately Confidently Strongly Enthusiastically Recommender s Signature Date Please Print Name: If new circumstances alter this student s status at school after you have submitted this form, please notify us as soon as possible. This application is for the UGA Pre-College Program only. All Pre-College applicants must apply for admission if they wish to enroll in a subsequent term at the University of Georgia.

8 Teacher/Counselor Recommendation Form 2 Please complete the first section below and give this form to a current teacher or counselor. This form must be submitted in one of the following ways or it will be considered invalid: In a sealed envelope with the teacher s signature over the flap, along with your Pre-College application In a sealed envelope with the teacher s signature over the flap, mailed directly to the Pre-College office Faxed to the number above from an official school fax line FOR THE STUDENT TO COMPLETE: Name: Home Phone: ( ) Date of Birth: / / Name of Recommender: Position: Subject(s) Taught: Phone: I authorize the above person to release information and provide an evaluation about any and all information from my/my child s education records; including information pertaining to my/my child s education at other institutions that I/he/she have previously attended which is a part of the record. I understand further that: (1) I have the right not to consent to the release of my education records; (2) I have a right to receive a copy of any written reference upon request; (3) and that this consent shall remain in effect until revoked by me, in writing, and delivered to the above recommender, but that any such revocation shall not affect disclosures previously made by said recommender prior to his/her receipt of any such written revocation. Check one: I waive ( ), do not waive ( ) my right to see the recommendation or other information prepared pursuant to this release. Student/Parent/Guardian Signature Date: FOR THE RECOMMENDER TO COMPLETE: The above student has applied to the University of Georgia Pre-College Program. While here, he/she will experience life on a college campus, including challenging academic courses, social activities and a great deal of independence. We are interested in information that will help us evaluate this student s potential to succeed in such an environment. Feel free to use a separate sheet of paper if you need more space for comments. Please evaluate the applicant in the following areas, using his or her entire class for comparison. Academic motivation and interest Intellectual ability Emotional maturity Social interaction with peers Ability to work as part of a team Ability to work independently Ability to cope with pressure Outstanding (Top 5%) Excellent Above Average Average Below Average continued on second page

9 Please illustrate the student s motivation and work habits in the classroom. UGA Pre-College Summer Programs 2011 How does this student express his/her creativity and imagination? Describe any special talents or exceptional experiences you know this student to possess. Personal comments are extremely important in the selection process. We would appreciate a frank and full statement about this applicant, including an assessment of intellectual and personal qualities, an indication of any particular strengths and weaknesses, and your opinion about this student s potential to succeed in the Pre-College Program. To the best of your knowledge, has this student incurred serious or repeated disciplinary action, been suspended or left voluntarily for an extended period of time? Y N If yes, please explain. I recommend this applicant for admission to the University of Georgia Pre-College Program. For academic promise For character and personal promise Overall Not recommended Moderately Confidently Strongly Enthusiastically Recommender s Signature Date Please Print Name: If new circumstances alter this student s status at school after you have submitted this form, please notify us as soon as possible. This application is for the UGA Pre-College Program only. All Pre-College applicants must apply for admission if they wish to enroll in a subsequent term at the University of Georgia.

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