Pre-engineering Application

Student Data

SSN:______-____-______

Name - First:______________ Middle:_________ Last:____________________

Address:_________________________________________________________

City:______________________ State:_____________ Zip:_________________

Parent or Guardian Data

Name – First:____________ Middle:__________ Last:_____________________

Work Phone:___________________ Alternate Phone:_____________________

Name – First:____________ Middle:__________ Last:_____________________

Work Phone:___________________ Alternate Phone:_____________________

Academic Information

Previous School Attended:________________ Grade Level:______ Year:______

Extra Curricular Activities:____________________________________________ ________________________________________________________________

Awards:__________________________________________________________

Non-Academic Information

Extra Curricular Activities:____________________________________________ ________________________________________________________________

Awards:__________________________________________________________

Last three books read (Title and Author):________________________________

________________________________________________________________

Top three favorite books (Title and Author):______________________________

________________________________________________________________

Interests:_________________________________________________________

________________________________________________________________

Hobbies:_________________________________________________________

________________________________________________________________

High School Plans

Will you be in the either of the following programs? (Circle one): IB AP

List any extra curricular activities that you plan on participating in while at CHS:___________________________________________________________

_______________________________________________________________

Optional Submissions:

For further consideration, students may submit an essay of 300 to 500 words on one of the following two topics:

• Why I am Interested in the pre-engineering program.
• My technical Hobbies.
• Why I read what I read.

In addition, students may submit no more than two letters of recommendation from someone familiar with their interest in engineering and/or technology or their character.

Essay Attached: Yes No Letters of Recommendation: One Two None