Apply to the Carnegie mellon Pre-College Program

2009 Pre-College Program Application Form

June 27 to August 7, 2009

Personal Information:

Last Name

First Name

Middle Name

Mailing Address

City

State

Zip

Home Phone # ex: 412 555-1212

Mobile Phone # ex: 412 555-1212

Email Address

Date of Birth MM/DD/YYYY

City & Country of Birth

Gender:

Male Female

Are you a citizen of the United States?

Yes No Permanent Resident # or Visa status

Is English your native language?

Yes No

(if not, TOEFL or IELTS required if your SAT Critical Reading score is below 600.)

If you would like to be identified as a member of a particular group, please indicate (optional):

Carnegie Mellon seeks to draw students from all ethnic and racial backgrounds.

African American, Black
Native American, Alaska Native (tribal affiliation) (enrolled)
Asian, including Indian Subcontinent (country)
Hispanic, Latino (country)
Mexican American, Chicano
Native Hawaiian, Pacific Islander
Puerto Rican
White or Caucasian
Other (specify)

Background Information:

High School Name

High School Phone # 412 555-1212

CEEB Code What's my CEEB code?

Current Grade

Advisor/Counselor's Name

Expected major(s) in college

I learned about the program through:

The New York Times
Dramatics Magazine
Teacher/Guidance recommendation

Peterson's Summer Opportunities Guide
Received brochure in the mail
College Bound Magazine

Private Colleges and Universities
Next Step Magazine
Other

Is either parent an employee of Carnegie Mellon?

Yes No

Parent's Name

Is either parent an alumnus/a of Carnegie Mellon?

Yes No

Parent's Name

Have you attended Carnegie Mellon's Pre-College Program before?

Yes No

Dates of Participation Program

I am applying for the following program(s):

If you are applying for more than one program, please indicate your order of preference between the AP/EA, Pre-College Fine Arts and the National High School Game Academy summer programs by ranking from 1 – 3 in the box space available below. 1 for most desired, 3 for least desired. Only rank the programs for which you have an interest.

Advanced Placement/Early Action (AP/EA)

Requested AP/EA Courses: (Course list should not be used to plan or construct a schedule. Courses are only representative of what will be available.)

Title

Title

Title

A request to take three courses (excluding chemistry lab) must be recommended by the student’s teacher or counselor and is subject to review by the director of the AP/EA program. Please request approval, in writing, to: William Alba, AP/EA Program Director, Doherty Hall 1324, Carnegie Mellon University, Pittsburgh, PA 15213. If approved, an additional non-refundable charge will be added to the student’s invoice.

National High School Game Academy

Please indicate your interest in either an art or programming focus.

Art Programming

University Housing

I desire accommodations in university housing during the program:

Yes No

Residents must be high school students who have completed their sophomore year and are 16 to 18 years old (born between August 7, 1990 and June 27, 1993). International students must be in the same age range with appropriate visas. Commuter students must be residents of Western Pennsylvania.

Signature

I certify that the information is accurate, original and completed to the best of my ability.

I have read and understand the statement above.

Parent Name

Parent/Guardian Address
(if different from applicant's)

City

State

Zip

Home Phone # 412 555-1212

Mobile Phone # 412 555-1212

Person to be reached in an emergency

Emergency Phone # 412 555-1212

Make a check payable to Carnegie Mellon for $40 and mail it to the address below along with all other required materials:

Pre-College Programs
Office of Admission
Carnegie Mellon University
5000 Forbes Ave
Pittsburgh, PA 15213

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