1. Name: ___________________________ 2. Soc. Sec. No.: _______________
3. Date of Birth: _______________ 4. Sex: Male Female (circle)
5. Home Address: ___________________________________________________
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6. Phone No. at Home (___)_______________7. Phone at School __________
8. Present School Address ___________________________________________
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9. Current Cumulative GPA ___________
10. Major Intended ______________11. Fall 1995 will be SOPH JR SR
12. Clubs, groups, teams at college_____________________________________
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13. Awards, prizes, scholarships_______________________________________
14. Current plans about career goal_____________________________________
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15. Programming Experience_____________________________________________
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