High school attended:

Name ________________________________________________________

Address ______________________________________________________

_____________________________________________________________

Years attended: ________ to ________

Highest grade completed: (circle) 9 10 11 12

Diploma: Yes No GPA (4.0 system): ________

Other high schools attended (names/dates):

__________________________________________________

__________________________________________________

High school equivalent:

GED (year:_____) Other (_____)

Favorite subjects: ______________________________________________

Major accomplishments:

______________________________________________________________

______________________________________________________________

Most recent college/university attended

Name ________________________________________________________

Address ______________________________________________________

_____________________________________________________________

Accredited institution: Yes No

Type: residential distance learning/online

Years attended: ________ to ________

Credit hours completed: ________ GPA: ________

Major(s): _________________________________

Minor(s): _________________________________

Degree: Yes No (When expect? __________)

Key skills acquired: ______________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Key accomplishments: ___________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Other college/university attended

Name ________________________________________________________

Address ______________________________________________________

_____________________________________________________________

Accredited institution: Yes No

Type: residential distance learning/online

Years attended: ________ to ________

Credit hours completed: ________ GPA: ________

Major(s): _________________________________

Minor(s): _________________________________

Degree: Yes No

Key skills acquired: ______________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Key accomplishments: ___________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________