First Name: • = required Last Name: • You are a: Choose... student parent guidance counselor other counselor other • Gender: Male  Female • Date of Birth: M 1 2 3 4 5 6 7 8 9 10 11 12   D 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   YYYY 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 •   E-mail Address: • Address: •   City: • State: State... AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY AB BC MB NB NF NS NT ON PE QC SK YT Outside the US • Zip: • Phone Number: •   H.S. Grad. Date: M 1 2 3 4 5 6 7 8 9 10 11 12 YYYY 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 • GPA: GPA... 4.0 3.9 3.8 3.7 3.6 3.5 3.4 3.3 3.2 3.1 3.0 2.9 2.8 2.7 2.6 2.5 2.4 2.3 2.2 2.1 2.0 1.9 1.8 1.7 1.6 1.5 1.4 1.3 1.2 1.1 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 •   High School: • Address: •   City: • State: State... AK AL AR AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY AB BC MB NB NF NS NT ON PE QC SK YT Outside the US • Zip: •   Submit 300-500 word essay: If you could pick one person -- living or dead, fictional or nonfictional -- to be your freshman year roommate, who would it be, and how would he or she help you succeed in college? •