Sincerely,

Ann KirschnerUniversity Dean

Macaulay H nors College The City University of New York 35 West 67

o

thStreet New York, NY 10023

Please download and print your Application Summary Package, which includes your applicationcontrol number, a summary of your Admission Application and important forms that must be usedwhen sending paper transcripts, payment and/or other supporting documents by mail.

Thank you for applying to Macaulay Honors College at CUNY.

September 2, 2010

Our application is designed to provide information about your preparation for our rigorous and excitingcourse of study. We look forward to learning more about you!

Macaulay offers an exceptional education for future leaders of New York City. Through unique,individualized advising, each Macaulay student develops a coordinated program that integratesacademic preparation, independent research, global learning, community engagement, closefaculty-student collaboration, and internships to explore and prepare for your future career aspirations.

Dear Mr. Dewey,

You can review the status of your application at any time at www.cuny.edu/status.

SAMPLE

Applicant's Last Name

Applicant's First Name

(Any prior last name used)

M I

Length of time at t he above address Length of time in N.Y.C.

Years / Months

Length of time in N.Y.S.

Mailing Address

Social Security Number

** If you do not have a SocialSecurity Number, check here.

Day Telephone Number E-mail Address

(if di�erent from above, or local address for in ternational applicants)

Please read the applic ation booklet before completing this application.

Please print all information in BLUE OR BLACK INK ( bold) and sign the form.

Applicant's Address

City State Zip Code

Years / Months Years / Months

Evening Telephone Number

City State Zip CodeCountry

1 2

3

4

4a 4b 4c

5

6 7 7a

Choice of College and Curriculum: Before entering your co llege choice, please refer to theinstructions. Indicate your choice in the boxes printed below, following the directions given.

Code College Name

CITY UNIVERSITY COLLEGE CHOICE

-1-

_

_

Apt. #

Apt. #

8b

8aIntended Major8

CONTACT INFORMATION

MaleFemale

** Record your social security number in the appropriate space. You are required to furnish your Social Security Account Number (SSAN). Your SSAN will beused as a unique identi�er for veri�cation of your identity, records maintenance, �nancial aid, and other purposes where it is necessary or practical to identifyyou by number. The authority for requiring disclosure of your SSAN is based upon Section 7(a )(2)(b) of the Federal Privacy Act. In addition, your SSAN shouldappear on all checks, money orders, applications, and documents sent to UAPC. If you do not have a social security number, a un ique identifying number willbe assigned to your �le. This will in no way a�ect your admission status.

Su�x (Jr., Sr.)

APPLICATION FOR ADMISSION TO THE CUNY MACAULAYHONORS COLLEGE: PERSONAL AND HIGH SCHOOL DATA FORM

Date of Birth

Month YearDay

I am considering preparing to become a teacher in:Early Childhood or Elem entary School

Middle School or Hig h School

AN

00

0

0

0

0

0

0

0

0

0

*** Student Copy ***

Hunter College

18/00

NYLKOORB

L

7

E

7

A

3

H

5

C

9

I

0

M

000

7330

VPUCCIARELLI@MSN.COM

YN

✔

6

W0000000000

LOCNIL00

00

3650

Y

9

E

2

W

2

E

1

D

2

EUNEV

SAMPLE

Questions 9-10: Citizenship status and alienage are used to determine if any other educational documents ar e needed to evaluate your application and to beginthe visa process for temporary visa applicants. They are also used to determine your eligib ility for available �nancial aid programs.

Are you a U.S. citizen? If no, please state:

Country of Birth

Country of Citizenship

Immigration Status:

-2-

9 10

Yes No

China: Mainland (032)

China: Taiwan (148) Hong Kong (170)

Korea (083)India (070) Vietnam (178)

The Philippines (121)

Bangladesh (012)

Israel (075)

Mexico (100)

Peru (120)

Colombia (033)

Cuba (038)

Dominican Republic (045)

Ecuador (046)

Guyana (065)

Haiti (066)

Jamaica (077)

Puerto Rico (185)

Trinidad (153)

England, Scotl and, or Wales (160)

Germany (056)

Barbados (013)

Greece (060) Ireland (074)

Italy (076)

Poland (122)

Russia (158)

Ukraine (223)

Other - specify

Born in the United States, excludingPuerto Rico or U.S. Territories

Born in Puerto Rico or U.S. Territories

Born outside of the United States

11

12

13

Yes No

Do you speak a language other than English at home? If yes, with which language do you feel more comfortable?

English Language other thanEnglish

Equally comfortablewith both

14

Your native language Other languages spoken14a 14b

Father's full name

Last Name First Name MI

15

Father living? Yes No

Citizen of U.S.? Yes No

Father's resi dence

City State Country

Father's occ upation

16

17

16a

Mother's full name

Last Name First Name MI

18

Mother living? Yes No

Citizen of U.S.? Yes No

Mother's resi dence

City State Country

Mother's occ upation

19

20

19a

Alien Registration (I551) Card #

Other

Date Obtained MM/YY Expiration Date MM/YYPlease Specify Type of Visa

U.S. permanent residentDate Obtained MM/YY

TemporaryVisa

Explain

AUTOBIOGRAPHICAL DATA

OSIS

Nigeria (113)

You Mother Father

Black or African A merican

Native Hawaiian or Other Paci�c Islander

AsianAmerican Indian or Alaska Native

Are you Hispanic / Latin o? Yes No

*** Student Copy ***

Where were you and each of your parents born?Check one in each column.

Response to Questions 11 through 13 is voluntary, and the information will be kept confidential. Refusal to provide this information will not affect your application.

✔

Indicate your race by selecting one or more options.

White

From what country or part of the world did you or your family originally come? (Check the box next to the name of the country or part of the worldwith which you most identify.)

SAMPLE

B. Current courses: If you are attending high school, list your senior year courses. Indicate any honors/college level/enrichment courses.

C. List any summer institutes or special programs you have attended during high school.

D. List any paid or volunteer jobs you have held during high school.

E. List any special talents/interests and honors or awards received.

F. List extracurricular activities (sports, clubs, band, yearbook, etc.) and community/volunteer activities. Include dates of participation and o�ces held.

-3-

Employer Name Type of Work Dates of Employment Hours Per Week

Activity Name Dates of Participation Offices Held

A. ESSAY:

21 Please answer the following questions. Use a separate sheet of paper, if necessary.

*** Student Copy ***

See attached.

SAMPLE

HIGH SCHOOL/SECONDARY SCHOOL INFORMATION

Name of High School

Date of actual or anticipated H.S. graduation

Month Year

H.S. Address

City State

22

22a

FOR UAPC USE ONLY

Are you a dependent of a veteran of the U.S. Armed Forces?

Yes No

23

-4-

ALL APPLICANTS MUST SIGN HERE

I understand that with this application, I am applying for the Honors College at The City University of New York.

I hereby certify that all the information in this application is accurate and complete. I realize that failure to �le the appropriate application may a�ect myadmission status. I understand that all the information contained in this application will be treated con�dentially and will be used for institutional purposesonly.

Applicant's Signature: Date:

24

NOTE: The City University of New York does not discriminate on the basis of age, sex, race, creed, color, national origin, physical or mental disability, sexualorientation, marital status, alienage or citizenship status, or veteran's status.

S R VTRAN ESL CSBATESTOEFLMV

University Application Processing CenterP.O. BOX 359021Brooklyn, NY 11235-0001

Send all completed application materials, along with theself-addressed postcard, in the envelope provided .(see inside back cover pocket)

If you are applying to the articulated BA/MD medical program at Brooklyn College, please contact the admissions o�ce at (718) 951-5001 for asupplemental application.

To ensure that your application is processed in a timely manner:

· Use paper clips, not staples, to attach documents to your application form.

· Print clearly on all application forms.

· Where possible, submit all documents at the same time. CUNY cannot begin processing your application until we have received every component, including fees and transcripts.

· Submit only one application.

WMV

*** Student Copy ***

1102

JOHN DEWEY HIGH SCH

NYBROOKLYN

60 ✔

SAMPLE

Recommender Nam

ge Application

2.

1.

Mrs. Sharon Doe

Mr. John Doe

CUNY Macaulay Honors Colle

StatusTypeDate SentE-mail Addresse

Recommendations

09/02/2010

09/02/2010

E-mail

E-mail

Incomplete

Incomplete

sharondoe@mail.com

johndoe@mail.com

SAMPLE

CUNY Macaulay Honors College Application Essay

Applicant Name: Date Submitted:

Control Number:

Michael Dewey September 02, 2010

Test

Page : 1

Evaluate a significant risk you have taken or ethical dilemma you have faced and discuss itsimpact on you. (500 words or less)

W0000000000

SAMPLE

CUNY Macaulay Honors College Application Essay

Applicant Name: Date Submitted:

Control Number:

Michael Dewey September 02, 2010

Test

Page : 1

Discuss some issue of local, national, or international concern and its importance to you. (500words or less)

W0000000000

SAMPLE

High School Transcript Request Form

Instructions: Print this form and submit to your school counselor or guidance office sothat your transcript may be forwarded to CUNY/UAPC.

Student Information

Graduation Date:

High School Information

To Whom It May Concern: I am applying to The City University of New York. Please send my high school transcript, including SAT or ACT scores (if applicable) to the following address:

CUNY/UAPC

Please do not include a copy of the application with this document.

Yours truly,

*HTRN*

Brooklyn, New York 11235-0001P.O. Box 359021

September 2, 2010

Mac

aula

y H

onor

s Col

lege

2011

Brooklyn, NY 11223

Macaulay Honors College Admission

50 Av XJohn Dewey High Sch

Michael Dewey

Michael Dewey

(H)W0000000000

SAMPLE

Instructions: Print and mail this return receipt along with your non-refundablecheck, money order, or CUNY Fee Waiver payable to CUNY/UAPC in a sealed envelopeto the following address:

CUNY/UAPC

Please do not include a copy of your application with this document.

Student Information

Graduation Date:

Check the method of payment included with this receipt.

Personal check in the amount of _____________

Money order in the amount of _____________

Official CUNY Fee Waiver # _____________

Application Fee Return Receipt

*FEES*

Brooklyn, New York 11235-0001P.O. Box 359021

September 2, 2010

Mac

aula

y H

onor

s Col

lege

2011

Macaulay Honors College Admission

Michael Dewey

(H)W0000000000

$65.00

SAMPLE

Document Return Receipt

Instructions: Print and mail this receipt along with any supporting documents required tocomplete your application. When possible, send all documents together in a singleenvelope. Please remember to affix proper postage. Mail your materials in a sealedenvelope to the following address:

CUNY/UAPC

Please do not include a copy of your application with this document.

Student Information

Graduation Date:

Application Control Number:

Check all the items included with this receipt.

Students Educated Within the United States

GED (Test Scores & Diploma)

SAT or ACT Score Report

Other ___________________________

Students Educated Outside the United States

Secondary School Transcript(s)

TOEFL Score Report

Translation(s) of Academic Record(s)

Other ___________________________

Brooklyn, New York 11235-0001P.O. Box 359021

September 2, 2010

Mac

aula

y H

onor

s Col

lege

2011

Macaulay Honors College Admission

Michael Dewey

(H)W0000000000

SAMPLE