| Full Name |
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YOUR SELF-DESCRIPTION: A description of what you are like as a person should point out your most significant accomplishments. Include information about your extracurricular and community activities, hobbies and primary interests, volunteer work, paid employment or work-study program. Include a statement of your personal ethics. Form and expression will be evaluaged.
Because legibility is important, please type on a separate sheet of paper. (Maximum 250 words.) |
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Present address
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Alternate Mailing Address
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Phone Number
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Social Security Number |
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High School last attended
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Date graduated or anticipate graduation |
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HONORS AND ACTIVITIES: For each grade (9-12), indicate with an "X" your principal activities/accomplishments, including offices, leadership positions, awards, or special recognition.
GRADE: |
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Ranking in class
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Grade point average |
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High school grading weighted/not weighted
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9 |
10 |
11 |
12 |
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Name of college/university where you are accepted & will attend
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O
F
F
I
C
E
S |
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school government |
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class |
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Address of college/university
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other school activity |
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other |
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Date term begins |
A
W
A
R
D
S |
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leadership |
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science, math |
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Field of study
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writing |
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music, art |
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Degree you will receive
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speech, debate |
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other |
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Expected date of receiving degree |
P
U
B
L
I
C
A
T
I
O N
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newspaper editor |
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yearbook editor |
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Parent (USBA member) Name
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literary magazine editor |
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poem, story, article |
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Parent (USBA member) address if different
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cartoon, photograph, drawing |
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other |
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I attest that all candidate information is complete and accurate.
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P
E
R
F
O
R
M
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lead in drama/musical |
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part in drama/musical |
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Candidate's signature & date
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orchestra, band, choral group |
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dance |
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Signature of USBA Member & date
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other |
S
P
O
R
T
S |
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letter or major award |
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team manager |
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other |
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IMPORTANT: Use separate sheet of paper to provide a personally prepared, typed essay, maximum of 250 words, outlining career objective. |
O
T
H
E
R |
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Attach copies of official SAT or ACT score report (if not already listed in official school transcript), and letter of acceptance as a full-time student by a college/university in the United States or District of Columbia. |
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