List Any Distinctions Or Honors You Have Earned and the Year Earned

Name Address Social Security Number

Honors and Awards (List any distinctions or honors you have earned and the year earned) Sample Award Award Year

Extracurricular and Personal Activities (List your principal extracurricular activities. Include specific events and/or major accomplishments such as varsity letters earned, etc. Start with the most recent and work backward in your listing. Include any relevant descriptions if you believe the reader will not know of a particular activity. Most people know what an Eagle Scout or student body president means. However, if you are a member of the “Start Club” be sure to provide a brief description.)

Activity Grade Level Approximate Time Spent Positions Held

Hours per week Weeks per year

Activity Year Hours Weeks Position Description

Community Service (List any meaningful volunteer/community service you have held during the last three years)

Nature of Work Employer Approx. Dates of Hours per Week/ Employment Weeks per Year

Position Employer Dates

Work Experience (List any job you have held during the last three years; include summer jobs, baby sitting, etc.)

Nature of Work Employer Approx. Dates of Hours per Week/ Employment Weeks per Year

Position Employer Dates

Supplemental Material (Use this section to describe activities you believe may be unknown to the committee. This section is optional.) 2