*First Name *:

*Last Name *:

*Phone Number *:

*Email Address *:

*Mailing Address *:

*City *:

*State *:

*Zip Code *:

*Academy/High School *:

*Address *:

*City *:

*State *:

*Zip *:

*Have you completed the following?:

• 4 years of English
• 2 years of History
• 3 years of Mathematics (including Algebra ll)
• 1 year of Biology
• 1 year of Chemistry
• 1 year of Physics

If not, please explain why:

Was your grade in these courses above a 2.0?:

*Cumulative GPA (CPI) *:

*ACT composite *:

*SAT cumulative *:

*Activities *:
List musical organizations, drama groups, athletic teams, honor societies, clubs, etc. noting years of participation.

*Church and Community *:
List church responsibilities and any community activities.

*Honors or Awards *:
List all of the honors or awards that you have received.

*Work Experience *:
List the jobs held during the last two years, including summers.

*Reading *:
What books have you read more than once in the last four years (excluding school assignments)? (If you have never read a book more than once, write a paragraph describing a favorite book, other than the Bible.

*Short Essay *:
Write a short essay (200-300 words) as to why you would like to be in the PUC Honors program and what you believe you could contribute to the program.

*Long Essay *:
In a slightly longer essay (500 words) write about a book (other than the Bible) that has influenced the way you think. Please be specific in discussing the positive and/or negative aspects of the text's influence.