Feel free to make copies of this form for further distribution 1

June 29–July 27, 2012 (No class on Wednesday, July 4th)

Monday–Friday 7:45 a.m.–1:45 p.m.

APPLICATIONS DUE: April 27, 2012

Minimum Eligibility Requirements:

• MUST be a graduating SENIOR entering a 4-YEAR college or university in fall 2012

• Be committed to daily program attendance, class participation, and timely completion of assignments

• Be presently or formerly eligible for free or reduced school lunch program • Be currently attending a high school in the Los Angeles area • Be accessible by e-mail, Facebook, or by phone once a semester while in college

SUMMER WRITING AND COLLEGE PREPARATION PROGRAM for SENIORS

Feel free to make copies of this form for further distribution 2

Student Contact Information

Name: ________________________________ Current High School: ___________________

Address: ______________________________ Overall GPA: _________________________

City and ZIP code: ______________________ E-mail: _______________________________

Home Phone: __________________________ Cell Phone: ___________________________ The best way to contact you: _______________________________________________________ (If you say “by phone,” also include the best time to call you.)

Gender: Female □ Male □ Date of Birth: ___________________________

College Preparatory Activities

Not required for admission, but useful for the program staff to know. Check all that apply.

□ Upward Bound □ Talent Search □ College Match

□ I AM Program □ One Voice □ USC NAI

□ AVID □ Fulfillment Fund □ HOLA Other College Support/Preparation Programs: _________________________________________

Family and Academic Background Information Estimated Household Income for last year (2011): $_____________________ Household size (number of family members): __________________________ Father’s highest education level completed: ___________________________ Mother’s highest education level completed: ___________________________

Please indicate scores for tests you’ve taken: SAT total score ____ Reading ____ Math ____ Writing ____

ACT total score ____ English ____ Reading ____ Math ____ Science ____

Ethnicity: □Latino/a: (specify) ________________ □Filipino □Native American/Alaska Native: (specify) ________________ □African American □Asian/Asian American: (specify________________ □White, Non-Hispanic □Native Hawaiian/Other Pacific Islander: (specify) ________________ □ Other, please specify:

__________________ Languages other than English I speak: ______________ Is English your second language? □Yes □No Are you a legal resident of California? □ Yes □ No (There is no residency requirement.) I qualify for (check one): □ Free lunch □ I do not currently qualify, but I did until: ___________ (year) □ Reduced lunch □ None of the above

Feel free to make copies of this form for further distribution 3

Additional Required Documents

You must submit the following FOUR items with your application:

□ Personal statement: 2 pages; 400 word minimum; double-spaced; 12-point font (Times New Roman); include a full introduction, body, and conclusion to your essay. Address the following prompt:

What are the talents, contributions, or personal qualities you will bring to the SummerTIME Program?

□ 1 copy of your high school transcript (UNOFFICIAL copy is acceptable)

□ 1 Letter of Recommendation in a Sealed Envelope: Ask a teacher or counselor to complete the attached recommendation form and to return it to you in a sealed envelope. You will submit the recommendation letter with this application.

□ 1 copy of your Financial Aid Award Letter from the college or university you will attend in the fall. If you do not have that letter yet by the time this application is due, please check here:

□ I do not yet have my college financial aid award letter. I will contact my college for a copy of this letter. I will in turn submit a copy to the SummerTIME program at my earliest convenience.

College Admission

Name of college or university you will attend beginning fall 2012:

Instructions for SummerTIME Application

You may either mail in your completed application or e-mail your application (with any included attachments) with the following materials above.

Mailing Address: E-mail Address: Pullias Center for Higher Education pullias@usc.edu University of Southern California If you will be emailing your completed application 3470 Trousdale Parkway, WPH 701 please make sure to save the SummerTIME Los Angeles, CA 90089-4037 application PDF with your first and last name.

(Example: SummerTIME.Tommy.Trojan.pdf)

If you have questions, you may contact Diane Yoon at 213.740.2996 or by email at dyoon@usc.edu