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Personal Profile Form
Urban Scholars Program Application—Personal Profile Form
Gender:
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Male
PID:
Applicant Name:
Mailing Address:
Home Phone:
Cell Phone:
Best Time to Call:
Email Address:
Date of Birth:
Place of Birth:
High School Name:
Type of School:
Public
Private
Charter School
Guidance Counselor:
Counselor Phone:
Counselor Fax:
Majors or Careers:
Please list the majors or careers that you are considering. (You may list one or more interests or "undecided.")
Honors Received:
Please list any honors or awards you have received during high school and the grade in which you received the honor.
Conferences or Conventions:
Please list any school related conferences or conventions in which you participated.
Hobbies/Special Interests:
Activities- Please list the activities you have been involved in, the positions you held and grades in which you participated in the activities.
For example: Student Council Treasurer, in grades 10,11,12
School Activities:
Extracurricular Activities:
Community Activities: