Date Received __________ (Office Use Only)
Please Type, or Print in Blue or Black Ink Only.
PART I. Personal Profile
Name_________________________________________ 900 # _______________
First Middle Last
Primary E-mail________________________ Secondary E-mail _______________________
Telephone No. ( )___________________ Cell Number ( )___________________
Area Code Number Area Code Number
If you have an on campus housing assignment, please use this information to complete the Local Address portion below. If you are living off campus at an address other than the permanent address listed above please use that information in the Local Address portion.
Local Address _________________________________________________________________
City State Zip Code
Birthday ____/____/_____ ____ Male ____ Female
Expected Graduation date: Class of _________ Cumulative GPA: __________
NOTE: If you are interested in engineering please do not state engineering as your major. At CAU you must first major in content area (biology, chemistry, computer science, mathematics, or physics). Therefore, state the content area then indicate engineering. See example.
Example: Intended Major Chemistry/Engineering
PART II. Background Information
*Please list the parent or guardian whose contact information is the same as your permanent address listed above.
Father’s Name _________________________________________________________________
Guardian’s Name _______________________________________________________________
High School Name ______________________________________________________________
Are you a first generation college student? _____Yes _____No
Unweighted High School Grade Point Average ___________
Cumulative Grade Point Grade Point Average ____________
SAT Score ___________
ACT Score ___________
Part III. Honors, Activities, and Achievements
*Please distinguish between high school and collegiate honors, activities, and achievements.
List honors and accomplishments from the past two years.
List organizations or clubs in which you are a member. Indicate any leadership roles held.
Identify any Advanced Placement courses or International Baccalaureate courses taken.
Identify talents or special interests you have; and highlight any notable experiences or activities of which you have been a part.
Please type and submit the following essay with your completed profile packet
Write a biographical sketch (no more than 1000 words) in a paragraph form. Please include the following information.
Profile packets and essays should be submitted no later than May 1, 2017 by email to Dr. Teri Platt, Interim Director of the Honors and Scholars Program at Clark Atlanta University, at email@example.com. Please contact us if you have questions or trouble submitting your information.