Applicant Information. References. Educational Data

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1 Applicant Information Student name: Student id: County: Permanent address: Permanent city: Permanent state: Permanent zip: Alternate Cell phone: Home phone: Birth date: Gender: Race or ethnic background: Citizenship: If permanent resident: Texas resident: References Reference 1 name: Reference 1 institution: Reference 1 mailing address: Reference 1 phone number: Reference 1 Reference 2 name: Reference 2 institution: Reference 2 mailing address: Reference 2 phone number: Reference 2 Educational Data Name of high school: City of high school: Intended major: Name of high school counselor: of high school counselor: Phone number of high school counselor: High school gpa: Scale: Graduation date: Class rank: Out of: Number tied for this rank:

2 PSAT Verbal: Math: Writing skills: Selection index: Date of test: SAT Critical reading: Math: Writing: Composite: Date of test: ACT Composite: Date of test: Indicate the level of recognition you have achieved in the following scholarship compeition(s). National merit: Date of national merit: National achievement: Date of national achievement: National hispanic: Date of national hispanic: Have you applied for admission to the honors college at unt: Have you been accepted for membership in the honors college at unt: Sophomore Level Coursework

3 Junior Level Coursework Senior Level Coursework

4 Employment, Activities, Service, and Awards Jobs

5 Orginizations and Activites

6 Service

7 Awards College Plans Will you be the first in your family to graduate college: Why have you chosen to apply to the university of north texas: 1: 2: 3: 4: 5: 6: What is our intended academic major: Why have you chosen your academic major:

8 Briefly describe any academic plans beyond earning your bachelors degree: What are some of your lifes goals and objectives: Have you ever been married: Students total income: Student presently lives with: Relation to student: Marital status: Annual salary: Occupation: Highest level of education achieved: 2013 income: Relation to student: Marital status: Annual salary: Occupation: Highest level of education achieved: 2013 income: Are you or your family receiving financial assistance such as social security from any local or federal government entity: Assistance Received Assistance 1 type: Assistance 1 amount: Assistance 2 type: Assistance 2 amount: Assistance 3 type: Assistance 3 amount: Value or your parents guardians other investments not including home: Value or your parents guardians businesses farms and or ranches not including home: Parents or guardians adjusted gross income for 2013 from form a: Was your familys 2013 income the same as it was for 2012: Did it increase or decrease: Estimated amount of change: Please provide the information for all children less than 25 years of age in your household.

9 Child 1 Child 2 Child 3 Child 4 Child 5

10 Child 6 Number attending college in including yourself: Funds for college saved by you: Funds for college saved by others: Do you have a texas tomorrow fund or 529 college savings plan: What is the plans value: Projected parental support for your college expenses annual amount: Parents guardians total cash savings not limited to college: Please describe any additional factors or circumstances demonstrating your financial need: List other scholarships for which you have applied a the University of North Texas for the academic year List other scholarships for which receive at the University of North Texas for the academic year

11 Powered by TCPDF ( Essays Essay 1 significant event and its impact: Essay 2 leadership experience: Digital signature:

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