First Name
Last Name
Street Address
City
State
Zip Code
Cell Phone Number
CWID
E-Mail Address
Academic Major
Concentration
Class Level Freshman (0-29 Semester Units) Sophomore (30-59 Semester Units) Junior (60-89 Semester Units) Senior (90+ Semester Units)
Cumulative GPA
Please identify your experience in leadership activities (if any).
Please list your involvement in relevant extra-curricular activities.
