Cornell: 2011 Transfer Application

Cornell
2011 Transfer Application

University
Admissions and Financial Aid Timeline for Transfer Students
If you are unable to meet a deadline, please call, email, or write to the Undergraduate Admissions Office or Office of Financial Aid and Student
Employment. Admissions deadlines may be extended if we are contacted early enough with a valid reason to do so. If we do not receive a request for an
extension within a timely manner, we may not be able to grant the extension. Financial Aid application materials should be submitted online or post-
marked by the deadline provided.
What’s Due Spring Transfer Applicants Fall Transfer Applicants

Transfer Common Application and $70 fee (or waiver) September 1 to October 1 February 1 to March 1
online or to the Transfer P.O. Box

Cornell University Transfer Supplement (with essays) September 1 to October 1 February 1 to March 1
online or to the Transfer P.O. Box
All other required application components including September 1 to October 1 February 1 to March 1
official transcripts, Instructor Evaluation, College
Official’s Report, and Midterm Report to the
Transfer P.O. Box
Transfer Financial Aid Application to the October 1 March 1

Transfer P.O. Box
A copy of your and your parents’ federal income tax October 1 March 1
return, including W-2s and all schedules filed, to the
Transfer P.O. Box
CSS PROFILE completed online at www.collegeboard.com October 1 March 1
FAFSA completed online at www.fafsa.ed.gov October 1 March 1
Admission decisions are sent as they are made November April and May
Financial aid notifications to accepted students November April and May
who applied for aid
Please make sure you have received your aid decision
before you make your decision about enrolling at Cornell
Acceptance deposit Early January, or two weeks after you receive Your acceptance deposit is due within 30 days of the date
Cornell’s offer and financial aid package, on the offer of admission letter or July 1, whichever is
whichever is later sooner. Your deposit should be postmarked no later than
the due date. If your deposit is not received or postmarked
by the due date, the university cannot guarantee housing
for you.
For More Information Academic Information Online Applications

We look forward to receiving your If you have questions about the academic programs We strongly encourage you to apply online to
application. If you have general ques- or admissions policies of a specific undergraduate expedite the processing of your application
tions about admissions or financial college at Cornell, please contact the appropriate and to better serve you. The online version is
aid, please call or check our website: college directly at the telephone number or email available at www.commonapp.org.
Undergraduate Admissions Office address provided: Note: If you are requesting a fee waiver,
Telephone: 607.255.5241 Agriculture and Life Sciences please check the fee waiver box on the online
Fax: 607.255.0659 Telephone: 607.255.2036 Common Application and mail your fee waiver
Email: transfer@cornell.edu Email: cals_admissions@cornell.edu request to the Transfer P.O. Box.
Website: admissions.cornell.edu
Architecture, Art, and Planning
Office of Financial Aid and Student Telephone: 607.255.4376
Employment Email: aap_admissions@cornell.edu Mailing Instructions
Telephone: 607.255.5145 All transfer application materials should be sent to:
Fax: 607.255.6329 Arts and Sciences
Telephone: 607.255.4833 Transfer Admissions
Email: finaid@cornell.edu
Email: as_admissions@cornell.edu Cornell University
Website: finaid.cornell.edu
P.O. Box 6411
Engineering Ithaca, NY 14851-6411
Telephone: 607.255.5008
Email: engr_admissions@cornell.edu The Transfer Financial Aid Application and federal tax
Hotel Administration returns should be sent to:
Telephone: 607.255.6376 Transfer Financial Aid
Email: hotelschool_admissions@cornell.edu Cornell University
P.O. Box 6411
Human Ecology
Ithaca, NY 14851-6411
Telephone: 607.255.5471
Email: humec_admissions@cornell.edu
Industrial and Labor Relations
Cornell University is an equal-opportunity, affirmative-action
Telephone: 607.255.2222 educator and employer. Produced by Office of Publications and
Email: ilr_admissions@cornell.edu Marketing at Cornell University 8/10 100301
Admissions Information and Special Requirements For Transfer Students
College Admission Options Transcripts Standardized Tests Special Requirements
Agriculture and Fall and spring • High school and college SAT and ACT not required Prerequisite courses required for each
Life Sciences Landscape architecture: fall only • Required Midterm Report International students: TOEFL or IELTS major; portfolio required for landscape
• Submit results of any external exams (Cornell’s institutional TOEFL code is architecture; no interviews offered;
such as AP, IB, or A Levels 2098; the departmental code is 00) visits encouraged well before applica-
tion deadline; for more information:
www.cals.cornell.edu/transfer.cfm
Architecture, Fall and spring • High school and college SAT or ACT if taken previously Five-year architecture: an interview and
Five-year architecture: fall only, unless • Required Midterm Report International students: TOEFL or IELTS a file portfolio that meets department
Art, and you have completed two years in an • Submit results of any external exams (Cornell’s institutional TOEFL code is specifications
Planning accredited architecture program such as AP, IB, or A Levels 2098; the departmental code is 00) Fine arts: a slide and/or CD portfolio that
meets department specifications; inter-
view recommended
History of architecture: two years of
undergraduate study; a two-semester
history of architecture survey course
Arts and Fall and spring • High school and college SAT or ACT if taken previously Students entering as juniors must
• Required Midterm Report International students: TOEFL or IELTS complete any prerequisites for their
Sciences • Submit results of any external exams (Cornell’s institutional TOEFL code is major field; for prerequisites,
such as AP, IB, or A Levels 2098; the departmental code is 00) consult the departmental websites
and Cornell’s Courses of Study for
details; no interviews offered; visits
encouraged
Engineering Fall only • High school and college SAT or ACT, and SAT Subject Tests if Students must complete any
• Required Midterm Report taken previously prerequisites for their major; applicants
• Submit results of any external exams International students: TOEFL or IELTS must submit complete course descrip-
such as AP, IB, or A Levels is required (Cornell’s institutional tions and/or syllabi for consideration;
TOEFL code is 2098; the departmental no interviews offered; visits encour-
code is 00) aged; for details on prerequisites and
course description submission, see
www.engineering.cornell.edu/transfer
Hotel Fall and spring • High school and college SAT, ACT, and SAT Subject Tests can Interview required, on or off campus.
Administration • Required Midterm Report be submitted, but are not required You must schedule your interview
• Submit results of any external exams International students: TOEFL or IELTS online by the corresponding fall or
such as AP, IB, or A Levels is required (Cornell’s institutional spring transfer application deadlines.
TOEFL code is 2098; the departmental Details at www.hotelschool.cornell.edu
code is 00)
Human Ecology Fall and spring • High school and college SAT, ACT, and SAT Subject Tests can Prerequisite courses for each major
• Required Midterm Report be submitted, but are not required can be found at www.human.cornell.
• Submit results of any external exams International students: TOEFL or IELTS edu/admissions/transfers; no inter-
such as AP, IB, or A Levels (Cornell’s institutional TOEFL code is views offered; appointment with an
2098; the departmental code is 00) admission counselor prior to applying
is strongly recommended
Design students: a portfolio and design
index are required for apparel design,
apparel and textile management, and
interior design options
Industrial and Fall and spring • High school and college SAT and ACT not required An interview is required and may
• Required Midterm Report International students: TOEFL or IELTS be conducted over the telephone if
Labor Relations • Submit results of any external exams (Cornell’s institutional TOEFL code is necessary
such as AP, IB, or A Levels 2098; the departmental code is 00)
2011 Transfer Application Instructions and Application Checklist
Important Information for Cornell Transfer Applicants

We are pleased that you are considering applying to Cornell University. It is important that you submit your Transfer Common Application and fee as soon
Our admissions committees review application materials thoughtfully and as possible during the appropriate transfer filing period. The Cornell University
thoroughly. We look forward to receiving your application and getting to Transfer Supplement can be sent at the same time or later, but do not delay: your
know you. Cornell University Transfer Supplement identifies the college to which you are
The Cornell transfer application consists of: applying, and the sooner we have this information, the sooner we can forward your
file to the appropriate committee for review.
• the Transfer Common Application, which Cornell uses exclusively (includes pages
AP-1 to AP-5, College Instructor Evaluation, and College Official’s Report) There are two ways to apply: online or on paper.
• a $70 application fee or waiver We strongly recommend that you apply online to expedite the processing of your
• the Cornell University Transfer Supplement to the Transfer Common Application, application and to better serve you. Whichever method you choose, you must
which is required of all applicants. It includes important Cornell-specific informa- submit all components the same way. Students who submit the Transfer Common
tion and required essays Application online must pay online (unless requesting a fee waiver), and must sub-
mit the Cornell University Transfer Supplement online. Students who submit their
• official copies of college and high school transcripts
Transfer Common Application on paper must pay by check or money order and must
• required Midterm Report submit the Cornell University Transfer Supplement on paper as well to the Transfer
• the 2011 Transfer Financial Aid Application (for applicants planning to apply for P.O. Box (see mailing instructions). All additional materials (financial aid application,
financial aid) transcripts, instructor evaluation, etc.) must be sent to the Transfer P.O. Box.
All applicants must complete specific college requirements as noted on

the grid on the previous page.
The Transfer Common Application Transfer Supplement

Submitting the Transfer Common Application and the $70 application fee • Use the online version at www.commonapp.org to submit the Transfer
(or fee waiver—see instructions in this booklet) begins the admissions pro- Common Application and the Cornell Transfer Supplement. All other
cess and should be done as soon as possible. application materials (financial aid application, transcripts, instructor
It is important to submit your Transfer Common Application as early as evaluation, etc.) must be sent in hard copy to the Transfer P.O. Box. or
you can for several reasons: • Use the paper copy included in this application booklet. Neatly
1. You will avoid delays in the processing of your application. Cornell handwritten, printed, or typed responses to the questions are acceptable.
receives applications from more than 3,000 prospective transfer students Send all materials to the Transfer P.O. Box.
each year. Spring transfer applicants will hear back from us in November. Please include your name, home address, and date of birth on all attached
Fall transfer applicants should know that it can take us 4–6 weeks to pro- sheets.
cess and review each application from the time of receipt.
Please note: Complete and submit the Transfer Common Application with
2. When we receive your Transfer Common Application and fee, we will the application fee only once to Cornell. Do NOT send duplicate copies
email you with the information you need to establish an online applica- through the mail or online unless you are specifically asked to do so by the
tion status account on Cornell’s website. Please note that receiving an admissions office.
ApplicantID via email is your confirmation that we have received your
application. Using this secure site, you will be able to track your applica- We encourage you to view the personal parts of the Transfer Common
tion materials and update your Email address when necessary. If you do Application, and in particular the Personal Statement, as opportunities to
not receive an ApplicantID within two weeks of submitting the Transfer think about yourself and reflect on what is important to you. Give careful
Common Application to Cornell University, it may be because your Email thought to the questions that are asked, but don’t try to write the answers
address is incorrect or you are blocking Email from us. Go to our website you think we want to hear. Give us answers that tell us about you.
(admissions.cornell.edu), click on “Check Application Status,” and follow Your application must be postmarked or submitted online by October 1 for
the instructions to obtain your ApplicantID. Use the troubleshooting feed- spring 2011 transfer admission, or by March 1 for fall 2011 transfer admis-
back form if you continue to have problems. sion.
Application Status Important Email Instructions

How to Submit
If you thequestions
have any Transferabout
Common Application
the status and
of your the Cornell
application, It is important that you provide us with a legible, current email address that you
see: admissions.cornell.edu/selfservice check frequently. Email is our primary tool for communicating with you to request
missing application materials, to verify information, to give you special instruc-
tions, etc. Please carefully type or print your email address on the application
form, being certain that characters are understood (for example, using Ø for zero
and noting the difference between a lower case l, the number 1, and the letter I).
Please also be sure to include cornell.edu in your address book and/or remove any
spam blockers that might prevent our email from reaching you.
2011 Transfer Application Instructions and Application Checklist Continued
Application Fee/Fee Waiver Midterm Report

Cornell’s application fee is $70, and you are required to submit it with your The Midterm Report is a required part of the Cornell transfer application,
Transfer Common Application. Please note that Cornell cannot process your and we ask that applicants submit this form as close to midterm as possible.
application without the application fee or fee waiver. Remember that if you
apply online, you must pay online. If you are submitting a paper applica- International Applicants
tion, you must pay by check, draft, or international money order with your
International Applicants must complete and submit all required application docu-
full name and home address written on the check so that we can accurately
ments and components. See the application checklist below and the college-
record your fee payment. Your check, draft, or international money order must
specific requirements detailed in the front of the application booklet. Before you
be drawn on a U.S. bank and made payable to Cornell University.
complete and submit the Transfer Common Application, the Cornell University
You can apply for an application fee waiver by Transfer Supplement, and other required forms, international applicants should
• sending in the College Board Fee Waiver form or review the Cornell Admissions website, as it contains information for international
applicants as well as the International Financial Aid Application. Application instruc-
• submitting a letter from a transfer advisor or representative of a social tions can be found on our website at admissions.cornell.edu/apply/applications.cfm.
service/community agency stating that the fee would cause financial
hardship.
If you cannot apply for a waiver by one of these methods, please contact the Helpful Application Tips
Undergraduate Admissions Office (607.255.5241) for further information. If • Give yourself enough time before the deadline to complete both the
you are submitting your application on paper, your fee waiver request should Transfer Common Application and Cornell Transfer Supplement.
be sent attached to page AP-1 of the Transfer Common Application (pages
• Pages can get separated, so include your full name and date of birth on every
AP-1 to AP-5). If you are submitting your application online, check the
page.
fee waiver box on the application and mail your fee waiver request to the
Transfer P.O. Box address (see mailing instructions for complete address). • For grouping of multiple pages for mailing, use of paperclips is requested (do
not staple).
Cornell University Transfer Supplement • After completing your application and supplement, make copies for yourself.
This required form provides us with essential information about your aca- • Set up your online application status account by following the instructions you
demic interests. The admissions staff at Cornell carefully reads and evaluates receive after submitting the Common Application form.
your response to the academic interest essay. The information you provide • Be sure to submit all items on the application checklist below.
helps us determine how good a match exists between your intellectual goals
and the Cornell college or school to which you are applying.
The Cornell Transfer Supplement must be submitted online if your Transfer Application Checklist
Common Application was submitted online. If you are submitting your appli- See instructions for submitting the various required application compo-
cation on paper, please attach your answers to the Cornell-specific essays to nents at the front of the transfer application booklet.
the Cornell Transfer Supplement form. You can submit this information with All Transfer Applicants
your Transfer Common Application or separately. Be sure to include your
name, home address, and date of birth on all attached sheets. ____ Transfer Common Application (pages AP-1 to AP-5)
____ $70 Application Fee or Fee Waiver
Required Interviews
For applicants to the School of Hotel Administration, the School of Industrial ____ Cornell University Transfer Supplement
and Labor Relations, or to the architecture program in the College of
____ Instructor Evaluation (pages IE–1 to IE–2)
Architecture, Art, and Planning, a formal interview is required for admission.
Applicants to the art department in the College of Architecture, Art, and ____ College Official’s Report (pages OR–1 to OR–2)
Planning are also encouraged (though not required) to have an interview. Note: The College Official’s Report must be submitted, but it is
• For architecture or fine arts applicants to the College of Architecture, not necessary to have a college dean complete the form. You are
Art, and Planning, use the online interview request form (www.aap.cor- welcome to ask a college/faculty advisor, college registrar, or other
nell.edu/admissions) or call 607.255.4376 to schedule an interview. college official who has access to your academic record and your
disciplinary record.
• Submit an online request form to the School of Hotel Administration
(www. hotelschool.cornell.edu) to schedule an interview by the corre- ____ Required Midterm Report
sponding spring or fall transfer application deadline.
____ Final high school transcript (secure official copy and send with your
• Applicants to the School of Industrial and Labor Relations should call
application materials)
607.255.2222 to schedule an interview.
____ College transcript(s) (secure official copy from all colleges attended and
College Instructor Evaluation send with your application materials)
Transfer applicants to Cornell are required to submit one College Instructor
Evaluation. A copy of the College Instructor Evaluation form is included in ____ Have official test score reports sent from testing agencies to Cornell
this application booklet. If you desire to send additional instructor recommen- (Note: the SAT, ACT, and SAT Subject Tests are not required for transfer
dations, you may download and print the forms at www.commonapp.org. Be applicants, but some Cornell colleges would like to see the results if you
sure to remind individuals writing recommendations for you to include your have taken these tests)
full name and date of birth on all pages.
____ Complete course descriptions and syllabi for College of Engineering
applicants only (for submission instructions, see
College Official’s Report
www.engineering.cornell.edu/transfer)
The College Official’s Report is a required part of the Cornell transfer applica-
tion. A registrar, college faculty/advisor, or other college official who has access ____ Required interview for applicants to the School of Hotel Administration,
to your academic record and your disciplinary record must complete this report. the School of Industrial and Labor Relations, or the architecture program
The official should complete the form to the best of his or her ability. The sec- the College of Architecture, Art, and Planning.
tion of the form regarding academic standing and disciplinary record is required.
2011 Transfer Financial Aid Instructions for U.S. Citizens
and Permanent Residents
Applying for Financial Aid

Cornell has a need-blind admissions policy, which means that we review your admissions application without considering whether
you’ve applied for aid; Cornell awards all financial aid on the basis of demonstrated financial need.
U.S. citizens, U.S. permanent residents*, and applicants who have been granted refugee or asylee status* are eligible to apply for financial assistance, and
should follow the instructions listed below.
International students must apply for aid by submitting the International Financial Aid Application (found on the Cornell Financial Aid website).
When you apply for aid, be sure to fully adhere to the financial aid application deadlines.
Spring 2011 Transfer Applicants— Fall 2011 Transfer Applicants—

Complete the four steps below and refer to the timetable for deadline Complete the four steps below and refer to the timetable for deadline
information. information.
1 Complete and submit the 2011 Transfer Financial Aid Application. 1 Complete and submit the 2011 Transfer Financial Aid Application.
2 Register for and complete the online College Scholarship Service 2 Register for and complete the online College Scholarship Service
(CSS) PROFILE. (CSS) PROFILE.
Connect to College Board online at www.collegeboard.com. Cornell's Connect to College Board online at www.collegeboard.com. Cornell's
CSS code is 2098. Your data will be sent electronically to Cornell CSS code is 2098. Your data will be sent electronically to Cornell
within three weeks of completion. within three weeks of completion.
If your parents are divorced, separated, or were never married, If your parents are divorced, separated, or were never married,
your noncustodial parent must complete the Noncustodial Parent your noncustodial parent must complete the Noncustodial Parent
PROFILE. Instructions are available when you complete your PROFILE. Instructions are available when you complete your
PROFILE. PROFILE.
3 Send us a signed copy of your and your parents’ (both custodial and 3 Send us a signed copy of your and your parents’ (both custodial and
noncustodial) 2009 federal income tax returns, schedules, and W-2 noncustodial) 2010 federal income tax returns, schedules, and W-2
forms. If you or your parents did not file a tax return for a given year, forms. If you or your parents did not file a tax return for a given year,
please provide a signed and dated statement, including any earnings please provide a signed and dated statement, including any earnings
for that year, and an explanation of why you were not required to file a for that year, and an explanation of why you were not required to file
tax return. An example of a Tax Non-Filer Statement is at www.finaid. a tax return. An example of a Tax Non-Filer Statement is at www.
cornell.edu. finaid.cornell.edu.
4 Complete the Free Application for Federal Student Aid (FAFSA) 4 Complete the Free Application for Federal Student Aid (FAFSA)
online at www.fafsa.ed.gov. online at www.fafsa.ed.gov.
The Cornell Title IV Institution Code number is 002711. Your FAFSA The Cornell Title IV Institution Code number is 002711. Your
data will be sent electronically to Cornell within three weeks of com- FAFSA data will be sent electronically to Cornell within three weeks
pletion. of completion.
* If you are applying for aid as a U.S. permanent resident, or have been granted refugee or asylee status: Submit a black and white copy of both sides of
your Alien Registration Receipt Card (form I-551) or a copy of your passport or departure record (I-94) with appropriate endorsements to verify your
status. To be considered for aid, you must be able to document your permanent resident status by November 1 for spring transfers and by July 1
for fall transfers.
If unable to document permanent residency status by the deposit date, you must submit the International Financial Aid Application. Questions con-
cerning aid for those applying for permanent residence should be directed to finaid@cornell.edu.
How should I submit my financial aid application and tax returns?

Tax returns and the Transfer Financial Aid Application can be submitted to our office in a variety of ways. Please include your name and date of birth on
each page.
• You may upload them securely on our website—click on “Submit Application Materials Electronically.”
• You may also fax materials to 607.255.6329.
• Mail to:
Transfer Financial Aid
Cornell University
P.O. Box 6411
Ithaca, NY 14851-6411
(Please do not staple documents.)
2011 Transfer Financial Aid Application for U.S. Citizens
and Permanent Residents
Deadlines (Postmark Dates)
Spring-semester applicants: October 1
Fall-semester applicants: March 1
Please send this form to the address below. U.S. citizens, U.S. permanent
residents, and applicants who have been granted refugee or asylee status Please type or print.
are required to submit this form in order to apply for financial assistance.
Student Name: ______________________________________________
International students should complete the International Financial Aid last
last firstfirst middle middle
Application found on the Cornell Financial Aid website (finaid.cornell.edu). Address: ___________________________________________________
Be sure to adhere to the financial aid application deadlines listed. If you _____________________________________________________________
have questions or concerns, please contact the Office of Financial Aid and
Student Employment. U.S. Social Security Number: ______________________________
Student Email: ___________________________________________
Transfer Financial Aid
Cornell University Parent Email: ______________________________________________
P.O. Box 6411
Ithaca, NY 14851-6411
Fax: 607.255.6329
International students should complete the International Financial Aid Application found on the Cornell Financial Aid website (finaid.cornell.edu).
All applicants: To be considered for any Cornell-administered financial assistance, complete and return this form to the address above by the noted due
dates. Attach signed copies of your and your parents’ federal (U.S., Puerto Rican, or other) income tax returns, including all schedules and W-2 forms, or a
signed statement indicating that a tax return was not filed. Financial Aid Applications received without either 2009 or 2010 tax returns, or a letter of
explanation, are considered incomplete and cannot be processed.
• Spring-semester applicants: Complete the 2010—11 College Scholarship Service (CSS) PROFILE online at www.collegeboard.com and the 2010–11 Free Application for Federal
Student Aid (FAFSA) and provide a copy of your parents’ 2009 federal income tax returns by October 1.
• Fall-semester applicants: Complete the 2011—12 CSS PROFILE online at www.collegeboard.com and the 2011–2012 FAFSA, and provide a copy of your and your parents' 2010 federal income tax
returns by March 1.
• The FAFSA Title IV school code for Cornell University is 002711. The school code for the CSS PROFILE is 2098.
This section to be completed by the student:

■ List all postsecondary institutions attended (from most recent to least recent) and dates of attendance:
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
■ Check the box that applies to your status:
U.S. citizen
U.S. permanent resident*: enclose a copy of your alien registration card
U.S. refugee/asylee*: enclose a copy of your alien registration card
* If you are applying for aid as a U.S. permanent resident, refugee, or asylee, you must be able to document your permanent resident status by your admission acceptance deposit date. If unable to document permanent resident status you should complete
the International Financial Aid Application.
■ Check each box that applies to your family situation:

Parents married Parents separated** _____________ Father remarried _____________ Father deceased _____________
Parents never married** Parents divorced** _____________
date date
Mother remarried _____________ date
Mother deceased _____________
date date date
** If your parents are separated, divorced, or were never married, include your custodial parent's information on the CSS PROFILE and FAFSA. Your noncustodial parent should file the Noncustodial PROFILE (instructions provided by
CSS when you file the PROFILE). If either parent is remarried, his or her current spouse's information must be included. Please explain any special circumstances on a separate page.
Please provide the name and address of the parent with whom you do not reside (if the address is not available, please explain on a separate page):
______________________________________________________________________________________________________________________________________________________
name number and street city state zip or postal code
■ Are you in default on any student loans? Yes No If yes, please name the institution(s) at which default occurred, state the
type(s) of loan(s) in default, and list the amount(s) of the default: __________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________
■ Identify the sources and list the amounts of all resources available for college expenses in the 2011—12 academic year.
Scholarships, prizes, and other awards: ________________________________________________________________________________ $ _________________________
Veterans’ educational benefits: _________________________________________________________________________________________ $ _________________________
Tuition benefit from parent’s employer: ________________________________________________________________________________ $ _________________________
■ If you are applying for consideration as an independent student, you must provide the following information (check all that apply):
I have not been, and will not be, claimed by my parents as an exemption on federal or state income tax returns for the 2008, 2009, 2010,
and 2011 calendar years.
I have not resided, and will not reside, at my parents’ home for more than a total of six weeks in calendar years 2008, 2009, 2010, and 2011.
I have not received, and will not receive, more than $750 from my parents in calendar years 2008, 2009, 2010, and 2011.
I was born before January 1987.
Unless you meet these four criteria, your parents must complete the section below and submit their financial data on the CSS PROFILE
and FAFSA. If you meet all four criteria, submit only your own financial data on the CSS PROFILE and FAFSA. (The four criteria are subject to
change by federal regulation or university policy at any time.)
This section to be completed by the parent:

■ Provide information below for all your (the parent’s) dependent children. Attach an additional page if necessary. If you provide significant financial support to someone
who is not your son or daughter, please attach an explanation of the relationship, circumstances, and amount of support provided. Please note for all college siblings
listed below, Cornell will require verification of enrollment from the sibling’s college registrar. The Cornell student’s aid will be reduced if a sibling listed as enrolled does
not attend full time for the full academic year.
For 2011–2012 School Year
Claimed

on federal Name of anticipated school: Estimated Estimated Estimated Estimated
tax return If college, Year in Full-time tuition and room and scholarships parent
Name DOB 2010? Name of present school Undergrad (U) or Grad (G)? school student? fees board or gift aid contribution
Student applicant _______ ____ __________________ Cornell (U) _____ Yes To be determined by Cornell University
________________________ _______ ____ __________________ ______________________ _____ ____ ________ ________ ________ ________
________________________ _______ ____ __________________ ______________________ _____ ____ ________ ________ ________ ________
________________________ _______ ____ __________________ ______________________ _____ ____ ________ ________ ________ ________
■ If you (the student’s parents) are divorced, separated, or were never married, write in the amount of child support received by the custodial parent during 2010 for the
student. $_____________________________
■ Do you (the parent) own all or part of a business? Yes No A farm? Yes No Are you self-employed? Yes No
     
■ Write in payments to tax-deferred pension and savings plans (paid directly or withheld from earnings) as reported on W-2 forms in Box 12, codes D,
E, F, G, H, and S. Include untaxed portions of 401(k) and 403(b) plans. $_____________________________
■ Write the total amount of Social Security benefits received by the family for 2010. $_____________________________
■ Note the student's share of Social Security benefits received for 2010. $_____________________________
■ Are you making payments on educational loans? Yes No If yes, please specify for whom the payments are made, the type of loan,
the current amount owed, and the expected 2010 monthly payments. __________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________________________________
■ Use a separate page to provide additional information that you want to be considered in the student’s application for financial aid.
Student/Parent Certification Both student and parent must sign below.

We understand that we must furnish signed copies of our tax returns, all supporting schedules, and all W-2 forms, and that we may be asked to
provide official IRS transcripts at any time.
I (the student) understand that if I am a Title IV federal aid recipient, this aid will be credited to my account to cover all educational expenses.
Such expenses may include, but are not limited to, tuition/fees, room and board, and items such as extra course fees, and the student health
insurance plan. If I elect to have federal aid credits limited to tuition/fees and room and board, I will notify the Office of Financial Aid and
Student Employment, in writing, to this effect.
We certify that all information is correct at this time and that we will notify the Office of Financial Aid and Student Employment promptly, in
writing, of any changes in our financial circumstances, and provide any other requested information or documentation. Furthermore, we understand
that changes in financial circumstances include: receipt of outside scholarships in any amount, changes in income or assets, and change in school or
enrollment status of other children. We understand that these may result in revisions to the applicant’s aid package. Finally, we understand that
the university may withhold or cancel financial aid if any requested information is not submitted.
We understand that information provided on this and other documents may be shared with the following: the applicant; state and federal agencies
from which we are requesting aid; and with donors. I authorize Cornell University to release financial aid information electronically.
We understand that the sources of financial aid funding for which the student is eligible may be limited if all required financial aid application
materials are not postmarked or submitted online by the listed deadline.
Signature of student: ____________________________________________________________________________________ Date: _____________________
Signature of parent or legal guardian: ______________________________________________________________________ Date: _____________________

Field of Study Codes
Transfer Major Codes
College of Agriculture and 170 Landscape architecture (accredited 350 Biological sciences (animal physiol- School of Hotel Administration
Life Sciences professional degree; landscape ogy; biochemistry; computational biol-
501 Hotel administration
design; community design; historic ogy; molecular and cell biology; ecol-
162 Agricultural science education (agri- • managerial communication
preservation; urban design and plan- ogy and evolutionary biology; general
cultural education; Cornell Teacher
ning; site construction; ecological biology; genetics and development; • financial management
Education)*
design; cultural landscapes) insect biology; microbiology; neurobiol- • food and beverage management
125 Agricultural sciences (broad education ogy and behavior; nutrition; plant biol-
175 Nutritional sciences (integrated study • human resources management
in agriculture; five concentrations ogy [botany and plant biotechnology];
of human nutrition, food, agriculture, • management operations
available) systematics and biotic diversity)
biology, and the social sciences)
130 Animal science (animal biology, genet- • marketing, strategy, and tourism
176 Plant sciences (general plant science; 351 Biology and society
ics, nutrition, physiology, and growth; • operations management and
floriculture and ornamental horticul- 360 Chemistry and chemical biology
dairy, livestock, and poultry production information technology
ture; fruit science; vegetable science; 359 China and Asia–Pacific studies
systems and management) • facilities management
plant biology; plant genetics and
140 Applied economics and management 361 Classics (Greek, Latin)
breeding; plant pathology; plant pro- • real estate, development, and law
(Cornell’s Undergraduate Business tection) 362 Comparative literature
Program; 10 specializations available) 190 Viticulture and enology (science of 363 Computer science
145 Atmospheric science (study of
College of Human Ecology
grape growing and winemaking) 397 Dance
weather and climate; forecasting and 650 Biology and society (biology, behavior,
182 Interdisciplinary programs (general 364 Economics
analysis of atmospheric behavior) and society; biology, health, and social
studies) 365 English policy; health and international devel-
110 Biological engineering (joint program Environmental Programs in the College of 330 Feminist, gender, and sexuality studies opment; ethical issues in biology)
with the College of Engineering) Agriculture and Life Sciences
370 Film 620 Design and environmental analysis
150 Biological sciences (animal physiol- 150 Ecology and evolutionary biology
366 French (interior design; facility planning and
ogy; biochemistry; computational biol- (apply to biological sciences) management; human factors and
ogy; molecular and cell biology; ecol- 376 German area studies
166 Environmental engineering (joint pro- ergonomics)
ogy and evolutionary biology; general 378 German (literature and culture)
gram with the College of Engineering) 680 Fiber science and apparel design
biology; genetics and development;
174 Natural resources (applied ecology; 379 Government (apparel design; apparel and textile
insect biology; microbiology; neurobiol-
ogy and behavior; nutrition; plant biol- resource policy and management; 381 History management; fiber science)
ogy [botany and plant biotechnology]; environmental studies) 382 History of art 640 Human biology, health, and society
systematics and biotic diversity) 179 Science of Earth systems (climate 368 Information science (biology and behavior; metabolism,
172 Biology and society (environmental dynamics; ocean sciences; biogeo- genetics, and health; biological and
383 Italian
impact of behavior; genetics and soci- chemistry; hydrological sciences; envi- social aspects of growth and develop-
ronmental geophysics; environmental 385 Linguistics ment; biology and public health policy;
ety; behavior and evolution; biology
and public policy) biophysics) 386 Mathematics biology and health promotion)
180 Biometry and statistics (statistics; 115 Science of natural and environmental 387 Music 630 Human development (human devel-
mathematical modeling; data analysis; systems (environmental science and 388 Near Eastern studies opmental behavioral neuroscience;
statistical computing; applications in applications of biological and physical 389 Philosophy cognitive development; law and human
biological, agricultural, environmental, sciences; relationship of economic development; aging and health; social
390 Physics
physical, and social sciences and and social systems with environmental and personality development)
issues) 391 Psychology
business) 660 Nutritional sciences (diet and
331 Religious studies disease; nutritional biochemistry;
160 Communication (communication in the
life sciences; communication media College of Architecture, Art, 352 Science and technology studies economic and global influences on
studies; communication and informa- and Planning 393 Science of Earth systems human health; nutrition and public
tion technologies; communication and health; human health and nutrition;
205 Architecture (five-year program) 394 Sociology
social influence) social influences on human nutrition;
215 Fine arts (painting; photography; 395 Spanish nutrition and fitness counseling)
178 Development sociology (community printmaking; sculpture; electronic 301 Statistical science 670 Policy analysis and management
development; environment and soci- imaging; combined media)
ety; population and development; 396 Theatre arts (economics and public policy; regula-
210 History of architecture (transfer tion and public policy; health care
social data and policy analysis; global 399 Undecided (within Arts and Sciences)
students only) policy; social welfare policy; demogra-
development)
225 Urban and regional studies (urban phy; policy analysis)
164 Entomology (insect biology; pest
history, government, politics, and College of Engineering
management; toxicology; systematics; 400 Biological engineering
sociology; urban and regional theory)
ecology and genetics; pathology) School of Industrial and
405 Chemical engineering
168 Food science (operations and man- Labor Relations
agement; biotechnology; basic food College of Arts and Sciences 410 Civil engineering
701 Industrial and labor relations
science) 310 Africana studies 415 Computer science
• labor relations, law, and history
155 Information science (creation and use 312 American studies 420 Electrical and computer engineering
• human resource studies
of information in digital form; relation- 314 Anthropology 425 Engineering physics
• international and comparative labor
ship between humans, information, 316 Archaeology 466 Environmental engineering
and technology; digital information in • labor economics
318 Asian studies 450 Information science, systems, and
social contexts) • organizational behavior
320 Astronomy technology
169 International agriculture and rural • social statistics
477 Science of Earth systems
development (special problems
and aspects of agricultural and 480 Materials science and engineering
sustainable development in 485 Mechanical engineering
developing countries) 490 Operations research and engineering
* Students interested in teaching mathematics or science must apply to major in the subject area in which they are interested.
For more information, please refer to education.cornell.edu.
Deadlines (Online Submission/
Postmark Dates)
Spring-semester applicants Oct. 1
2011 Cornell University Transfer Supplement Fall-semester applicants March 1
Please see the instructions in this booklet or at admissions.cornell.edu/apply/transfer prior to completing this form.
Name: _______________________________________________________________________________________________________________
Enter name exactly as it appears on passports last/family first middle
or other official documents.
U.S. Social Security number (optional): ________________________ Preferred name: ______________________________________________

Mailing address:_________________________________________________________________________________________________________
number and street
_____________________________________________________________________________________________________________________
city state or province zip + 4 or postal code county (if U.S.) country telephone
Date of birth: _________________________
month/day/year
Email address: ________________________________________________________________________________________________________

It is important that you provide us with a legible, current email address that you check frequently. Email is our primary tool for communicating with you to request
missing application materials, verify information, give you special instructions, etc. Please carefully type or print your email address on the application form, being
certain that characters are understood (for example, using Ø for zero and noting the difference between a lower case l, the number 1, and the letter I.) Please be sure
to include cornell.edu in your email address book and/or remove any spam blockers that might prevent our email from reaching you.
Cell phone number (optional): (_________)_______________________________________
area code
As a secondary tool for communication, we may occasionally provide additional information or special instructions via text messaging. If you have a text-enabled
cell phone, you can opt in to receive these messages by providing your cell phone number.
What was your major at your current/last attended college: _____________________________________________________________________
What system did your previous college use? ❑ quarter ❑ trimester ❑ semester ❑ year
Are you a member of your college’s Honors Program? ❑ Yes ❑ No
Are you applying as a (please check one): ❑ transfer ❑ visiting student
Have you applied for undergraduate admission to Cornell before: ❑ Yes ❑ No If so, for what term and year? __________________________
College or school at Cornell to which you are applying (choose only one):
❑ Agriculture and Life Sciences ❑ Arts and Sciences ❑ Hotel Administration ❑ Industrial and Labor Relations
❑ Architecture, Art, and Planning ❑ Engineering ❑ Human Ecology
Code number of your anticipated major within the college you’ve chosen above (select only one; codes are at the back of this booklet):
__________________________
Note to all applicants: Recognizing that transfer applicants have diverse academic talents and career interests that may be satisfied by more than
one of Cornell’s colleges/schools, your application may be reviewed by a college/school at Cornell in addition to the one to which you are applying.
Do you have parents, grandparents, or great-grandparents who attended Cornell? ❑ Yes ❑ No
_____________________________________________________________________________________________________________________
name dates he or she attended relationship (indicate whether parent/grandparent/great-grandparent) degree(s)
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Is a parent or guardian currently a Cornell faculty or staff member? ❑ Yes ❑ No
If so, name of that parent/guardian:_________________________________________________________________________________________

_____________________________________________________________________________________________________________________
2011 Cornell University Transfer Supplement continued
Name: ____________________________________________________________________________________ Date of birth: _________________
Academic Interest Essay (all applicants to complete):

Please address the topics below in an essay of approximately 500 to 750 words total.
Tell us what you’d like to major in at Cornell and why, how your past academic or work experience influenced your decision, and how transferring
to Cornell would further your academic interests.
College of Agriculture and Life Sciences Applicants Only:

Students in the College of Agriculture and Life Sciences are often interested in several major fields of study and take courses in more than one area.
Do you want to be considered for admission to an alternate-choice major in Agriculture and Life Sciences if you are not admitted to your primary-
choice major? ❑ Yes ❑ No If yes, indicate your alternate-choice major interest: _____________________________.
College of Engineering Applicants Only:

Please check to make sure that complete course descriptions and/or syllabi are submitted by the application deadline and clearly labeled with your
name and date of birth. We cannot evaluate your application without them. For submission instructions, see www.engineering.cornell.edu/transfer.
Students applying to the College of Engineering sometimes have a genuine interest in more than one major in Engineering. Do you want to be
considered by an alternate-choice major in Engineering if you are not admitted to your primary-choice major: ❑ Yes ❑ No
If yes, please submit an additional statement (approximately 500 words) discussing your interest in the major of ____________________________
(fill in blank with alternate-choice major).
College of Human Ecology Applicants Only:

In addition to completing the Academic Interest Essay, we are interested in learning how students address any life challenges they might have faced.
Please tell us how you approached a challenging circumstance and what resources you employed to deal with that issue. Your response should total
approximately 500 to 750 words.
New York State Residents Only

Are you enrolled in one of the following New York State opportunity programs at your current college/university: EOP, HEOP, College Discovery, SEEK?
❑ Yes ❑ No
If yes, please indicate the program: ❑ EOP ❑ HEOP ❑ College Discovery ❑ SEEK
Visiting Students Only

How many semesters do you plan to attend Cornell? _______________ Please list your proposed courses by semester.
Fall Spring
___________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Required for all applicants:

Reminder: You must submit your $70 application fee with the Common Application. If you are applying for a fee waiver, please select “Online Fee
Waiver Request” and mail your fee waiver form or letter to the Undergraduate Admissions Office. Visit admissions.cornell.edu for further informa-
tion regarding application fee waivers.
2010-11 TRANSFEr Application
For Spring 2011 or Fall 2011 Enrollment
APPLIC ANT
Legal name ___________________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.
Preferred name, if not first name (choose only one) ______________________ Former last name(s), if any _______________________________________
p Female p Male
Birth date ____________________________________________________ US Social Security Number, if any ___________________________________
mm/dd/yyyy Optional, unless applying for US Federal financial aid with the FAFSA form
E-mail address ________________________________________________ IM address ____________________________________________________
Permanent home address __________________________________________________________________________________________________________

Number & Street Apartment #
____________________________________________________________________________________________________________________________
City/Town County or Parish State/Province Country ZIP/Postal Code
Preferred Telephone p Home p Cell Home (_______) __________________________________ Cell (_______) __________________________________
Area/Country/City Code Area/Country/City Code
If different from above, please give your current mailing address for all admission correspondence.
Current mailing address (from ___________ to ___________) ____________________________________________________________________________

(mm/dd/yyyy) (mm/dd/yyyy) Number and Street Apartment #
____________________________________________________________________________________________________________________________
City/Town County or Parish State/Province Country ZIP/Postal Code
If your current mailing address is a college or university, include name of school here: _____________________________________________________________
FUTURE PLANS
Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college
chose not to ask that question of its applicants.
College ________________________________________________________ Deadline ______________________________________________________

mm/dd/yyyy
Entry Term: p Fall (Jul-Dec) p Spring (Jan-Jun) Do you intend to apply for need-based financial aid? p Yes p No
Academic Interests _____________________________________________ Do you intend to apply for merit-based scholarships? p Yes p No
Do you intend to be a full-time student? p Yes p No
____________________________________________________________
Do you intend to enroll in a degree program your first year? p Yes p No
____________________________________________________________ Do you intend to live in college housing? ______________________________
Career Interest _________________________________________________ What is the highest degree you intend to earn? _________________________
DEmogRAPhICS
Citizenship Status ______________________________________________ 1. Are you Hispanic/Latino?
Non-US Citizenship ______________________________________________ p Yes, Hispanic or Latino (including Spain) p No
_____________________________________________________________ Please describe your background ________________________________________________
_____________________________________________________________ 2. Regardless of your answer to the prior question, please indicate how you identify
yourself. (Check all that apply.)
Years lived in the US? ____________________________________________
p American Indian or Alaska Native (including all Original Peoples of the Americas)
Birthplace ________________________________________________________
City/Town State/Province Country Are you Enrolled? p Yes p No If yes, please enter Tribal Enrollment Number________________
First Language _________________________________________________ Please describe your background ________________________________________________
Primary language spoken at home _____________________________________ p Asian (including Indian subcontinent and Philippines)
Are you proficient in any other languages? _______________________________ Please describe your background ________________________________________________
_________________________________________________________________ p Black or African American (including Africa and Caribbean)

Please describe your background ________________________________________________
Optional The items with a gray background are optional. No information you
provide will be used in a discriminatory manner. p Native Hawaiian or Other Pacific Islander (Original Peoples)
Marital Status ____________________________________________________ Please describe your background ________________________________________________
Religious Preference _______________________________________________ p White (including Middle Eastern)
US Armed Services veteran? p Yes p No Please describe your background ________________________________________________
© 2010 The Common Application, Inc. AP-1 / 2010-11

FAmILY
Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information for demo-
graphic purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then please list that
information below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the Additional Information
section online, or on an attached sheet if applying via mail.
Household
Parents’ Marital Status (relative to each other): p Never married p Married p Widowed p Separated p Divorced (date ________________________)
mm/yyyy
With whom do you make your permanent home? p Parent 1 p Parent 2 p Both p Legal Guardian p Ward of the Court/State p Other
Parent 1: p Mother p Father p Unknown Parent 2: p Mother p Father p Unknown
Is Parent 1 living? p Yes p No (Date Deceased ____________________) Is Parent 2 living? p Yes p No (Date Deceased ____________________)
mm/yyyy mm/yyyy
____________________________________________________________ ____________________________________________________________
Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.) Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
Country of birth ________________________________________________ Country of birth ________________________________________________

Home address if different from yours Home address if different from yours
____________________________________________________________ ____________________________________________________________
____________________________________________________________ ____________________________________________________________
Preferred Telephone: p Home p Cell p Work Preferred Telephone: p Home p Cell p Work
(_______) ____________________________________________________ (_______) ____________________________________________________
Area/Country/City Code Area/Country/City Code
E-mail _______________________________________________________ E-mail _______________________________________________________
Occupation _____________________________________________________ Occupation _____________________________________________________
Employer _____________________________________________________ Employer _____________________________________________________
College (if any) ___________________________________ CEEB ________ College (if any) ___________________________________ CEEB ________
Degree _________________________________________ Year _________ Degree _________________________________________ Year _________
Graduate School (if any) ____________________________ CEEB ________ Graduate School (if any) ____________________________ CEEB ________
Degree _________________________________________ Year _________ Degree _________________________________________ Year _________
Legal Guardian (if other than a parent) Siblings

Please give names and ages of your brothers or sisters. If they are enrolled in
Relationship to you _______________________________________________ grades K-12 (or international equivalent), list their grade levels. If they have
attended or are currently attending college, give the names of the undergraduate
____________________________________________________________ institution, degree earned, and approximate dates of attendance. If more than
Last/Family/Sur First/Given Middle Title (Mr./Ms./Dr., etc.)
three siblings, please list them in the Additional Information section.
Home address if different from yours
____________________________________________________________
____________________________________________________________ Name Age & Grade Relationship
____________________________________________________________ College Attended ___________________________________ CEEB _______

Preferred Telephone: p Home p Cell p Work
Degree earned _________________________ Dates __________________
(_______) ____________________________________________________ or expected mm/yyyy – mm/yyyy
Area/Country/City Code
____________________________________________________________
E-mail _______________________________________________________ Name Age & Grade Relationship
College Attended ___________________________________ CEEB _______

Occupation _____________________________________________________
Employer _____________________________________________________ Degree earned _________________________ Dates __________________

or expected mm/yyyy – mm/yyyy
College (if any) ___________________________________ CEEB ________
____________________________________________________________
Name Age & Grade Relationship
Degree _________________________________________ Year _________
College Attended ___________________________________ CEEB _______
Graduate School (if any) ____________________________ CEEB ________
Degree earned _________________________ Dates __________________
Degree _________________________________________ Year _________ or expected mm/yyyy – mm/yyyy
EDUC ATIoN
Colleges & Universities Are you currently enrolled in college? p Yes p No
Current or most recent college or university attended_____________________________________________________________________________________
Entry Date __________________ Exit Date __________________ School Type p Public p Independent This is a p 2-year p 4-year institution
mm/yyyy mm/yyyy
Address ________________________________________________________________________________ CEEB/ACT code ___________________________
Number & Street
__________________________________________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
Advisor’s name (Mr./Ms./Dr., etc.) ______________________________________________ Advisor’s title __________________________________________
E-mail __________________________________ Telephone (_______) ______________________ Fax (_______) _________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number
List all other colleges or universities, including summer schools as well as summer and other programs, you have attended, beginning with your first year of college.
College/University Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Degree Candidate? Dates Attended Degree(s) Earned
Yes No (mm/yyyy)
_________________________________ ___________________________________________ p p __________________ __________________
_________________________________ ___________________________________________ p p __________________ __________________
_________________________________ ___________________________________________ p p __________________ __________________
Do you expect to earn a degree prior to enrolling at the college to which you are applying? p Yes p No If so, what type of degree? _________________________
Are you a member of Phi Theta Kappa? p Yes p No
Secondary Schools
List all secondary schools you have attended. Please have a School Report form, Official Transcript, and School Profile sent from each institution as soon as possible.
Name of School & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yyyy)
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
_____________________________________________ _______________________________________________________ ____________________
Secondary School Graduate Date __________________
mm/dd/yyyy
Please list any community program/organization that has provided free assistance with your application process: ______________________________________________
If your education was interrupted, please indicate so here and provide details in the Additional Information section:___________________________________________
AC ADEmICS
The self-reported information in this section is not intended to take the place of your official records. Please note the requirements of each institution to which you are
applying and arrange for official transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where “Best Scores” are
requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates.
Secondary
School Class Rank _________ Class Size _________ Weighted? p Yes p No GPA _________ Scale _________ Weighted? p Yes p No
Grades (if available) (if available)
ACT Exam Dates: ________ ________ ________ Best Scores: _________ ______ _________ ______ _________ ______
(past & future) mm/yyyy mm/yyyy mm/yyyy (so far) COMP mm/yyyy English mm/yyyy Math mm/yyyy
_________ ______ _________ ______ _________ ______
Reading mm/yyyy Science mm/yyyy Writing mm/yyyy
SAT Exam Dates: ________ ________ ________ Best Scores: _________ ______ _________ ______ _________ ______
(past & future) mm/yyyy mm/yyyy mm/yyyy (so far) Critical Reading mm/yyyy Math mm/yyyy Writing mm/yyyy
TOEFL/ Exam Dates: ________ ________ ________ Best Score: _________ ______ ______
IELTS (past & future) mm/yyyy mm/yyyy mm/yyyy (so far) Test Score mm/yyyy
AP/IB/SAT Best Scores: ________ __________________________________ _____ ________ __________________________________ _____

Subjects
(per subject, so far) mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score
________ __________________________________ _____ ________ __________________________________ _____
mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score
________ __________________________________ _____ ________ __________________________________ _____

________ __________________________________ _____ ________ __________________________________ _____
Current Courses Please indicate title, level (100-level, 200-level, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken in the
same semester on the appropriate semester line. If you’re not currently enrolled in college, please list the classes you took during 12th grade.
First Semester/Trimester Second Semester/Trimester Third Trimester
or additional first/second term courses if more space is needed
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
Honors Briefly list any academic distinctions or honors you have received since the 11th grade or international equivalent (e.g. National Merit, Cum Laude Society).
Grade level Honor Level of Recognition
School State/ National Inter-
11 12 FY SO JR Regional national
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
p p p p p _________________________________________________________________________________ p p p p
ExTRACURRICULAR ACTIvITIES & WoRk ExPERIENCE

Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and
paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (specific events, varsity letter, musical
instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a résumé.
Approximate When did you participate If applicable,
Grade level time spent in the activity? do you plan
Summer/ Positions held, honors won, letters earned, or employer
to participate
11 12 FY SO JR Hours Weeks School School
per week per year year Break in college?
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________
p p p p p p p ________________________________________________________________ p
Activity _________________________________________________________________________________________________________________

WRITINg
Short Answer Please briefly elaborate on one of your extracurricular activities or work experiences in the space below or on an attached sheet (150 words or fewer).
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Personal Essay This personal essay helps us become acquainted with you as a person and student, apart from courses, grades, test scores, and other objective
data. It will also demonstrate your ability to organize your thoughts and express yourself.
Please provide a statement (250 words minimum) that addresses your reasons for transferring and the objectives you hope to achieve, and attach it to your
application before submission. NOTE: Your Common Application essay should be the same for all colleges. Do not customize it in any way for individual colleges.
Colleges that want customized essay responses will ask for them on a supplement form.
Additional Information If there is any additional information you’d like to provide regarding special circumstances, additional qualifications, etc., please do so in the
space below or on an attached sheet.
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Disciplinary History
a Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from 9th grade (or the international equivalent)
forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from
the institution? p Yes p No
b Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? p Yes p No
[Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed,
annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]
If you answered “yes” to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and
reflects on what you learned from the experience.
SIgNATURE
Application Fee Payment If this college requires an application fee, how will you be paying it?
p Online Payment p Will Mail Payment p Online Fee Waiver Request p Will Mail Fee Waiver Request
Required Signature
w I certify that all information submitted in the admission process-including the application, the personal essay, any supplements, and any other supporting
materials-is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying
and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or
revocation of course credit, grades, and degree should the information I have certified be false.
w I acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditional,
pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.
w I affirm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of my
admission offers from all institutions. [Note: students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted from
the waitlist, provided that they inform the first institution that they will no longer be enrolling.]
Signature _______________________________________________________________________________________________ Date ___________________

mm/dd/yyyy
Common Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex,
age, marital status, parental status, physical disability, learning disability, political affiliation, veteran status, or sexual orientation.

2010-11 COLLEGE INSTRUCTOR EVALUATION IE
To ThE APPLIC ANT

After completing all the relevant questions below, give this form to an instructor who has taught you a full-credit college class. If applying via mail, please also give
that instructor stamped envelopes addressed to each institution that requires an Instructor Evaluation.
p Female
Legal name ___________________________________________________________________________________________________________________
p Male
Birth date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy (Optional)
Address ________________________________________________________________________________________________________________________
Number & Street Apartment # City/Town County or Parish State/Province Country ZIP/Postal Code
College or university you now attend ______________________________________________ CEEB/ACT code ______________________________________
IMPORTANT PRIvACY NOTE: By signing this form, I authorize all schools that I have attended to release all requested records covered under the Federal
Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by the Common Application member institution(s) to which I am applying.
I further authorize the admission officers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact
officials at my current and former schools should they have questions about the school forms submitted on my behalf.
I understand that under the terms of the FERPA, after I matriculate I will have access to this form and all other recommendations and supporting documents
submitted by me and on my behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).
2. I waive my right to access below, regardless of the institution to which it is sent:
p Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.
p No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or
on my behalf to the institution at which I’m enrolling, if that institution saves them after I matriculate.
Required Signature _______________________________________________________________________________________ Date _________________
To ThE INSTRUCToR
The Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. You are encouraged to keep this form in
your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below.
Instructor’s name (Mr./Ms./Dr., etc.) _______________________________________________________ Subject taught _______________________________

Please print or type
Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy
College or university _____________________________________________________________________________________________________________
School address ________________________________________________________________________________________________________________

Number & Street City/Town State/Province Country ZIP/Postal Code
Instructor’s telephone (_______) ________________________________________________ Instructor’s e-mail ____________________________________

Area/Country/City Code Number Ext.
Background Information
How long have you known this student and in what context? _______________________________________________________________________________
What are the first words that come to your mind to describe this student? _____________________________________________________________________
List the courses you have taught this student, noting for each the student’s year in school (first-year, sophomore, etc.) and the level of course difficulty
(100-level, 200-level; etc.).
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
© 2010 The Common Application, Inc. IE-1/ 2010-11
INSTRUCTOR EvALUATION 1
Ratings Compared to other students to whom you have taught this class, how do you rate this student in terms of:
very good One of the top few
Good (well above Excellent Outstanding I’ve encountered
No basis Below average Average (above average) average) (top 10%) (top 5%) (top 1%)
Academic achievement
Intellectual promise
Quality of writing
Creative, original thought
Productive class discussion
Respect accorded by faculty
Disciplined work habits
Maturity
Motivation
Leadership
Integrity
Reaction to setbacks
Concern for others
Self-confidence
Initiative, independence
OvERALL
Evaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in
your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attach an additional sheet or another reference you may
have prepared on behalf of this student.)

2010-11 COLLEGE INSTRUCTOR EVALUATION IE
To ThE APPLIC ANT

After completing all the relevant questions below, give this form to an instructor who has taught you a full-credit college class. If applying via mail, please also give
that instructor stamped envelopes addressed to each institution that requires an Instructor Evaluation.
p Female
Legal name ___________________________________________________________________________________________________________________
p Male

Address ________________________________________________________________________________________________________________________
To ThE INSTRUCToR
The Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. You are encouraged to keep this form in
your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below.
Instructor’s name (Mr./Ms./Dr., etc.) _______________________________________________________ Subject taught _______________________________

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy
College or university _____________________________________________________________________________________________________________
School address ________________________________________________________________________________________________________________

Number & Street City/Town State/Province Country ZIP/Postal Code
Instructor’s telephone (_______) ________________________________________________ Instructor’s e-mail ____________________________________

Area/Country/City Code Number Ext.
How long have you known this student and in what context? _______________________________________________________________________________
What are the first words that come to your mind to describe this student? _____________________________________________________________________
List the courses you have taught this student, noting for each the student’s year in school (first-year, sophomore, etc.) and the level of course difficulty
(100-level, 200-level; etc.).
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
Ratings Compared to other students to whom you have taught this class, how do you rate this student in terms of:
Good (well above Excellent Outstanding I’ve encountered
No basis Below average Average (above average) average) (top 10%) (top 5%) (top 1%)
Intellectual promise
Quality of writing
Creative, original thought
Productive class discussion
Respect accorded by faculty
Disciplined work habits
Maturity
Motivation
Leadership
Integrity
Reaction to setbacks
Concern for others
Self-confidence
Initiative, independence
OvERALL
Evaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in
your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attach an additional sheet or another reference you may
have prepared on behalf of this student.)

2010-11 COLLEGE OFFICIAL’S Report OR
To ThE APPLIC ANT

This form must accompany an official copy of your transcript and must be completed by a college official(s) who has access to your academic record
and your disciplinary record. Please follow these steps to ensure the form is completely accurately and in its entirety. Step 1: Complete all relevant questions
below, including the signature statement. Step 2: Give this form to a dean or college official who has access to your academic record and ask that official to com-
plete the academic portion of this form. Step 3: If the official completing the academic portion does not also have access to your disciplinary record, please ask the
individual to securely forward the form to a second official who can answer those questions before duplicating this form and mailing it to your colleges along with
copies of your official transcript(s).
p Female
Legal name ___________________________________________________________________________________________________________________ p Male

Address ________________________________________________________________________________________________________________________
College/university you now attend ________________________________________________ CEEB/ACT code ______________________________________
Current year courses—please indicate title, level, and credit value of all courses you are taking this year. Indicate quarter classes taken in the same semester on the
appropriate semester line.
First Semester/Quarter Grade Second Semester/Quarter Grade Third Quarter Grade
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
How many college credits have you earned prior to this academic year? ________ How many college credits will you earn this academic year? ________
To ThE CoLLEgE oFFICIAL

If you have access to the applicant’s academic record and disciplinary record, please complete this form in its entirety. Attach the applicant’s official transcript (check
copies for readability). Use both pages to complete your evaluation for this student, and be sure to sign below. If you have access to the applicant’s academic record only,
please complete the relevant portion of this form, then forward to the appropriate official for completion of the disciplinary questions, asking that official to mail the form
to the applicant’s colleges after doing so.
College official’s name (Mr./Ms./Dr., etc.) _____________________________________________________________________________________________
Signature _________________________________________________________________________________________________ Date _____________________
mm/dd/yyyy
Title ___________________________________________________________ College or university _____________________________________________
College or university address ______________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
College official’s telephone (_______) ________________________________
____ College official’s fax (_______) _____________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number Ext.
College or university CEEB/ACT code ___________________________ College official’s e-mail ___________________________________________________
mm/dd/yyyy
© 2010 The Common Application, Inc. OR-1/ 2010-11

Cumulative GPA: ________ on a _________ scale, covering a period from ____________ to ____________ School Seal
(mm/yyyy) (mm/yyyy)
This GPA is p weighted p unweighted. The school’s passing mark is ________________________________.
Highest GPA in class ____________________________________ Graduation date ___________________

(mm/dd/yyyy)
If you know this student, please indicate for how long and in what context. ____________________________________________________________________
If you know this student, what are the first words that come to your mind to describe this student? _________________________________________________
Ratings Compared to other students in his or her class year, how do you rate this student in terms of:
Good (above (well above Excellent Outstanding I’ve encountered
No basis Below average Average average) average) (top 10%) (top 5%) (top 1%)
Extracurricular accomplishments
Personal qualities and character
OvERALL
Evaluation Please provide comments that will help us differentiate this student from others. Feel free to attach an additional sheet or another reference you’ve
prepared for this student. We especially welcome a broad-based assessment and encourage you to consider describing or addressing:
• The applicant’s academic, extracurricular, and personal characteristics.
• Relevant context for the applicant’s performance and involvement, such as particularities of family situation or responsibilities, work obligations, or other
circumstances, either positive or negative.
• Observed problematic behaviors, perhaps separable from academic performance, that an admission committee should explore further.
If you are completing only the questions pertaining to the applicant’s disciplinary record, please provide the following information:
College official’s name (Mr./Ms./Dr., etc.) _____________________________________________________________________________________________
Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy
Title ___________________________________________________________ College official’s e-mail __________________________________________
College official’s telephone (_______) ________________________________

____ College official’s fax (_______) _____________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number Ext.
a Is this applicant in good academic standing? p Yes p No
b Is this applicant eligible to return to your school? p Yes p No
If you answered no to either or both questions, please attach a separate sheet of paper or use your written recommendation to provide details.
a Has the applicant ever been found responsible for a disciplinary violation at your school, whether related to academic misconduct or behavioral misconduct, that
resulted in the applicant’s probation, suspension, removal, dismissal, or expulsion from your institution? p Yes p No
b To your knowledge, has the applicant ever been convicted of a misdemeanor, felony, or other crime? p Yes p No
If you answered yes to either or both questions, please attach a separate sheet of paper or use your written recommendation to give the approximate date of each
incident and explain the circumstances.
p Check here if you would prefer to discuss this applicant over the phone with each admission office.
I recommend this student: p No basis p With reservation p Fairly strongly p Strongly p Enthusiastically
© 2010 The Common Application, Inc. OR-2/ 2010-11
2010-11 Mid-Term Report MT
To ThE APPLIC ANT

After completing all the relevant questions below, give this form to instructors whose courses you are enrolled in at the time you file your application and ask them to
provide a general indication of your performance, including your current grade and (if they wish) additional comments, and to sign and date the form. They should also
provide the course title, number, and credits.
p Female
Legal name ___________________________________________________________________________________________________________________ p Male

Address ________________________________________________________________________________________________________________________
To ThE INSTRUCToR
The Common Application membership finds it helpful to receive a general indication of how the student is performing in the courses he/she is currently enrolled in as
they choose from among highly qualified candidates. Be sure to sign below.
Course title/Department ___________________________________________________________________ Course number __________ Credits __________
Current grade ___________ Comments (optional) _______________________________________________________________________________________
Professor’s signature _____________________________________________________________________ Date __________________________________

© 2010 The Common Application, Inc. MT/ 2010-11
MID-TERM REPORT

Cornell: 2011 Transfer Application

Transféré par

Informations du document

Description originale:

Titre original

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Cornell: 2011 Transfer Application

Transféré par

Droits d'auteur :

Formats disponibles

Cornell

2011 Transfer Application

What’s Due Spring Transfer Applicants Fall Transfer Applicants

Transfer Financial Aid Application to the October 1 March 1

For More Information Academic Information Online Applications

College Admission Options Transcripts Standardized Tests Special Requirements

Important Information for Cornell Transfer Applicants

All applicants must complete specific college requirements as noted on

The Transfer Common Application Transfer Supplement

Application Status Important Email Instructions

Application Fee/Fee Waiver Midterm Report

Applying for Financial Aid

Spring 2011 Transfer Applicants— Fall 2011 Transfer Applicants—

How should I submit my financial aid application and tax returns?

This section to be completed by the student:

■ Check each box that applies to your family situation:

This section to be completed by the parent:

Student/Parent Certification Both student and parent must sign below.

Signature of parent or legal guardian: ______________________________________________________________________ Date: _____________________

U.S. Social Security number (optional): ________________________ Preferred name: ______________________________________________

Email address: ________________________________________________________________________________________________________

What was your major at your current/last attended college: _____________________________________________________________________

Are you a member of your college’s Honors Program? ❑ Yes ❑ No

Are you applying as a (please check one): ❑ transfer ❑ visiting student

❑ Architecture, Art, and Planning ❑ Engineering ❑ Human Ecology

Do you have parents, grandparents, or great-grandparents who attended Cornell? ❑ Yes ❑ No

Is a parent or guardian currently a Cornell faculty or staff member? ❑ Yes ❑ No

If so, name of that parent/guardian:_________________________________________________________________________________________

Name: ____________________________________________________________________________________ Date of birth: _________________

Academic Interest Essay (all applicants to complete):

College of Agriculture and Life Sciences Applicants Only:

College of Engineering Applicants Only:

College of Human Ecology Applicants Only:

New York State Residents Only

Visiting Students Only

Required for all applicants:

E-mail address ________________________________________________ IM address ____________________________________________________

Permanent home address __________________________________________________________________________________________________________

Current mailing address (from ___________ to ___________) ____________________________________________________________________________

College ________________________________________________________ Deadline ______________________________________________________

First Language _________________________________________________ Please describe your background ________________________________________________

_________________________________________________________________ p Black or African American (including Africa and Caribbean)

© 2010 The Common Application, Inc. AP-1 / 2010-11

Country of birth ________________________________________________ Country of birth ________________________________________________

E-mail _______________________________________________________ E-mail _______________________________________________________

Occupation _____________________________________________________ Occupation _____________________________________________________

Employer _____________________________________________________ Employer _____________________________________________________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Degree _________________________________________ Year _________ Degree _________________________________________ Year _________

Legal Guardian (if other than a parent) Siblings

____________________________________________________________ College Attended ___________________________________ CEEB _______

College Attended ___________________________________ CEEB _______

Employer _____________________________________________________ Degree earned _________________________ Dates __________________

AP/IB/SAT Best Scores: ________ __________________________________ _____ ________ __________________________________ _____

________ __________________________________ _____ ________ __________________________________ _____

ExTRACURRICULAR ACTIvITIES & WoRk ExPERIENCE

© 2010 The Common Application, Inc. AP-4 / 2010-11

Signature _______________________________________________________________________________________________ Date ___________________

© 2010 The Common Application, Inc. AP-5 / 2010-11

To ThE APPLIC ANT

Birth date __________________________________________________________________ Social Security # _____________________________________

College or university you now attend ______________________________________________ CEEB/ACT code ______________________________________

Signature of parent or legal guardian: __________________________________________________ Date: _

U.S. Social Security number (optional): Preferred name: ______________________

Name: ____________________________________________________________________ Date of birth: _

E-mail address IM address ____

Current mailing address (from _____ to _) ________________________________________________________________________

College __ Deadline

First Language _ Please describe your background

Country of birth Country of birth

E-mail _ E-mail _

Occupation _ Occupation _

Employer _ Employer _

Degree _____________________________________ Year _ Degree _____________________________ Year _

Degree _____________________________________ Year _ Degree _____________________________ Year _

________________________________ College Attended _ CEEB _

College Attended _____________________________ CEEB _

Employer _________________________________________ Degree earned _ Dates ______

AP/IB/SAT Best Scores: ________________________ _ ________________________ _

________________________ _ ________________________ _

Signature _____________________________________________________________________________ Date _

Birth date ______________________________ Social Security # _

College or university you now attend ________ CEEB/ACT code

Instructor’s name (Mr./Ms./Dr., etc.) _________________________ Subject taught _

Signature _____________________________________________________________________________ Date _

Instructor’s telephone (_) ______ Instructor’s e-mail

Birth date ______________________________ Social Security # _

College or university you now attend ________ CEEB/ACT code

Instructor’s name (Mr./Ms./Dr., etc.) _________________________ Subject taught _

Signature _____________________________________________________________________________ Date _

Instructor’s telephone (_) ______ Instructor’s e-mail

Birth date ______________________________ Social Security # _

College/university you now attend __________ CEEB/ACT code

Highest GPA in class __________________ Graduation date _

Signature _____________________________________________________________________________ Date _

Title _________________ College official’s e-mail

College official’s telephone (_) __________________________

Birth date ______________________________ Social Security # _

College or university you now attend ________ CEEB/ACT code

Course title/Department _______________________________________________________ Course number Credits

Current grade _ Comments (optional) _____________________________________________________________________________

Professor’s signature ___________________________________ Date

Course title/Department _______________________________________________________ Course number Credits

Current grade _ Comments (optional) _____________________________________________________________________________

Professor’s signature ___________________________________ Date

Course title/Department _______________________________________________________ Course number Credits

Current grade _ Comments (optional) _____________________________________________________________________________

Professor’s signature ___________________________________ Date

Course title/Department _______________________________________________________ Course number Credits

Current grade _ Comments (optional) _____________________________________________________________________________

Professor’s signature ___________________________________ Date

Course title/Department _______________________________________________________ Course number Credits

Current grade _ Comments (optional) _____________________________________________________________________________

Professor’s signature ___________________________________ Date