Honors Program Application

Disclosure: This form will be used in the decision process of admitting students into the Honors Program at Angelo State University. Information from this form may also be used to gather statistical information concerning this program.

The information you have supplied on this form is maintained by the University. You have the right to review and correct this information by contacting the Honors Program office.

Personal Information

Name
Date of Birth (MM/DD/YYYY)
Permanent Address	Street/Box No.
	City
	State Zip
Mailing Address (if different than above)	Street/Box No.
	City
	State Zip
Home Phone Number
Cell Phone Number
E-mail Address
What other universities are you applying to?
Did you father attend college?	Yes No
Did you mother attend college?	Yes No

Academic Information

High School Rank
High School Total Class Size
Top Percentile
High School GPA
GPA Scale (4 point, etc)
College GPA (if applicable)
Intended Major
Student Status
High School
Graduation Date
High School Location	City
	State Zip
SAT Test Score #1	Test Date Math Verbal Sat Total
SAT Test Score #2	Test Date Math Verbal Sat Total
ACT Test Score #1	Test Date English Math Reading Science ACT Composite
ACT Test Score #2	Test Date English Math Reading Science ACT Composite

Academic History

College or High School #1	Name
	Dates of attendance
	Address
College or High School #2	Name
	Dates of attendance
	Address
College or High School #3	Name
	Dates of attendance
	Address
College or High School #4	Name
	Dates of attendance
	Address

Courses

	List any courses for which you will bring in college credit.

Extracurricular Activities

	List 5 or fewer extracurricular activities (include weekly hours of participation and dates). Choose those activities that demonstrate overall ability and leadership skills.

Honors and Awards

	List all academic awards as well as honors received since you were a freshman in high school (include dates and organization that presented the award).

Volunteer, Community Service, and Employment History

	List 7 or fewer (include weekly hours of participation, dates, and type of activity).

Abilities and Values

	What personal abilities and values do you believe you would bring to the Honors Program at ASU? (250 words or less)

Expectations

	Why do you want to be in the Honors Program, and what do you expect to gain from your experience in the Honors Program at ASU? You may provide a list if you wish.

Additional Information

	Provide any additional information or statements that you would like the selection committee to consider when reviewing your application. (250 words or less)

References

List two academic references that you have asked to submit the ASU Honors Program Reference Form to support your application.

Reference #1	Name
	Address
	Phone Number
	Relationship
Reference #2	Name
	Address
	Phone Number
	Relationship

About Us

How did you find out about the Honors Program at Angelo State University?	Counselor Website Teacher Recruiter Student Other Please specify
I am interested in Honors Program housing:	Yes No
Provide the name of a friend, teacher, or counselor that you would like us to contact with more information about the Honors Program at Angelo State University.	Name
	Relationship
	Address
	City
	State Zip
	Phone
	E-mail

Consent

My electronic submission of this form demonstrates that I am the student named in this application/form and that all the information contained herein is accurate and current.

Name
Date

Who Are You?

Honors Program Application

Angelo State University

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