*First Name:

*Last Name:

*Phone Number:

*Email Address:

*Mailing Address:

*City:

*State:

*Zip Code:

*Academy/High School:

*Address:

*City:

*State:

*Zip:

*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.