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Sincerely, Ann KirschnerUniversity Dean
Macaulay H nors College The City University of New York 35 West 67
o
thStreet New York, NY 10023
Thank you for applying to Macaulay Honors College at CUNY.
Please download and print your Application Summary Package, which includes your application control number, a summary of your Admission Application and important forms that must be used when sending paper transcripts, payment and/or other supporting documents by mail.
You can review the status of your application at any time at www.cuny.edu/status.
Macaulay offers an exceptional education for future leaders of New York City. Through unique, individualized advising, each Macaulay student develops a coordinated program that integrates academic preparation, independent research, global learning, community engagement, close faculty-student collaboration, and internships to explore and prepare for your future career aspirations.
Dear Mr. Justice,
Our application is designed to provide information about your preparation for our rigorous and exciting course of study. We look forward to learning more about you!
September 6, 2013
SAMPLE
Expected Date of Entrance
Fall Spring Year
Applicant's Last Name
Applicant's First Name
(Any prior last name used)
M I
Length of time at the 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 Social SecurityNumber, check below.
Day Telephone Number E-mail Address, if available
Yes
No
Have you taken or do you plan to take the SAT I orACT? Note: If you are applying to a CUNYbaccalaureate program and are in your last year ofhigh school in the United States, or have graduatedfrom high school within the past year, you mustsubmit SAT I or ACT scores.
(if different from above, or local address for international applicants)
Applicant's Address
City State Zip Code
Years / Months Years / Months
Evening Telephone Number
City State Zip CodeCountry
1 2
5
5a 5b 5c
6
7 8 8a
9
Choices of Colleges and Curriculum: Before entering your college choices, please refer to the instructions. Indicate your choices in the boxes printedbelow, in order of preference. You may list up to six choices. You must enter both the code and the college name.
Code
1st Choice
Code
2nd Choice
College Name College Name
Code
3rd Choice
Code
4th Choice
College Name College Name
CUNY COLLEGE CHOICES
College NameCode
5th Choice
College NameCode
6th Choice
-1-
_
_
Apt. #
Apt. #
10b
10aIntended Major10
Date of Birth
Month YearDayMale
Female
3 4
Suffix (Jr., Sr.)
I am considering preparing to become ateacher in:
Early Childhood or Elementary SchoolMiddle School or High School
APPLICATION FOR ADMISSION TO THE CUNY MACAULAYHONORS COLLEGE: PERSONAL AND HIGH SCHOOL DATA FORM
STUDENT COPY
3 3 0 1 2 3
1 1 2 2 3
✔
3 6 F I V
17/00
E S
The City College
1 9 9 5
0 1 3 9
✔
J U S T I C E
1 6 8 0
N Y
Lehman College
0 6 3 9
B R O O K L Y N
N Y
✔
3 6 F I V E S
0 2 0 2 Baruch College
Brooklyn College
B R O O K L Y N
*** Student Copy ***
0 5 3 7
T R E E T
0 1
W0008129383
✔
2 8
T R E E T
8 9 0 0 5 8 9 5 7
John Jay College of Criminal Justice
Queens College
0 4 3 7
2 0 1 3
4
1
T
1
O
2
N
2
Y
3
7 1 8
SAMPLE
Questions 11-11a: Citizenship status and alienage are used to determine if any other educational documents are needed to evaluate your application and to begin the visa process for temporary visa applicants. They are also used to determine your eligibility for available financial aid programs.
Are you a U.S. citizen? If no, please state:
Country of Birth
Country of Citizenship
Immigration Status:
-2-
11 11a
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, Scotland, 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
12
12a
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 residence
City State Country
Father's occupation16
17
16a
Mother's full name
Last Name First Name MI
18
Mother living? Yes No
Citizen of U.S.? Yes No
Mother's residence
City State Country
Mother's occupation19
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 American
Native Hawaiian or Other Pacific Islander
AsianAmerican Indian or Alaska Native
Are you Hispanic / Latino? Yes No
STUDENT COPY
Response to Questions 12 through 13 is voluntary, and the information will be kept confidential. Refusal to provide this information will not affect your application.
Where were you and each of your parents born? Check one in each column.
✔
✔
What choice best identifies your ancestry or ethnic origin?
White
Indicate your race by selecting one or more options.
✔
✔
ENGLISH
✔
*** Student Copy ***
✔
✔
✔
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 offices held.
-3-
Employer Name Type of Work Dates of Employment Hours Per Week
Activity Name Dates of Participation Offices Held
A. ESSAY:
Please answer the following questions. Use a separate sheet of paper, if necessary.
21
STUDENT COPY
See attached.
*** Student Copy ***
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
23
-4-
EDUCATIONAL INSTITUTIONS ATTENDED
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
STUDENT COPYDates of
Attendance: From
BROOKLYN
N/A
NY
JOHN DEWEY HIGH SCH
JOHN DEWEY HIGH SCH
50 AV X
Dates of Attendance: To
REGENTS DIPLOMA
In order to match your supporting documents to your Admission Application, it is important that you:
Have you ever served in any branch of the U.S. Armed Forces?
If you are applying to the articulated BA/MD medical program at Brooklyn College, please contact the admissions office at (718) 951-5001 for a supplemental application.
B. What diploma or certificate did you receive when you completed the secondary school?
For additional instructions, please visit www.cuny.edu/afteryouapply
A. List the secondary schools that you have attended, beginning with the most recent. Applicants do not have the discretion of omitting any part of their educational history.
06/2013
Name of Institution
✔
✔
1. Attach your supporting documents to the appropriate forms included in your Application Summary Package.
2. Record your Application Control Number on each supporting document.
3. Send all of your documents to CUNY/UAPC together in a single envelope, when possible.
2 0 1 3Are you the dependent of someone who served in a branch of the U.S. Armed Forces?
*** Student Copy ***
No
No
Yes
Yes0 6
SAMPLE
ge Application
Recommender Nam
1.
2.
Mr. Engel
Mr. Pucciarelli
CUNY Macaulay Honors Colle
Incomplete
Recommendations
e E-mail Address Date Sent
09/05/2012
Type
09/05/2012
Status
E-mail Now
E-mail Now
Incomplete
SAMPLE
STUDENT COPY
STUDENT COPY
Control Number: W0008129383 Page: 1
CUNY Macaulay Honors College Application Essays
Applicatant Name: Tony Justice Date Submitted: September 05, 2012
Discuss some issue of local, national, or international concern and its importance to you. What are thechallenges it raises, problems to be addressed, and hopeful outcomes? (500 words or less)
SAMPLE
SAMPLE
STUDENT COPY
STUDENT COPY
Control Number: W0008129383 Page: 1
CUNY Macaulay Honors College Application Essays
Applicatant Name: Tony Justice Date Submitted: September 05, 2012
It is 4 p.m. on Tuesday. What will you do next? Write about your extracurricular pursuits. Why and how do youchoose the activities you are involved in? How do your activities reflect your values and affect your school,community or the world? (500 words or less)
SAMPLE
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
Date of Birth: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*
36 Five Street
Mac
aula
y H
onor
s Col
lege
Brooklyn, NY 11223
W0008129383
September 6, 2012
Tony Justice
Tony Justice
(H)
01/28/1995
Macaulay Honors College Admission
50 Av XBrooklyn, NY 11223
P.O. Box 359021Brooklyn, New York 11235-0001
2013
John Dewey High Sch
SAMPLE
Instructions: Print and mail this return receipt along with your non-refundable check, 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 Date of Birth: 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*
36 Five Street
Mac
aula
y H
onor
s Col
lege
Brooklyn, NY 11223
W0008129383
September 6, 2012
$65.00
Tony Justice
(H)
01/28/1995
Macaulay Honors College Admission
P.O. Box 359021Brooklyn, New York 11235-0001
2013
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
Date of Birth: 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 ___________________________
(H)
36 Five Street
Mac
aula
y H
onor
s Col
lege
01/28/1995
Brooklyn, NY 11223
Macaulay Honors College Admission
W0008129383
P.O. Box 359021Brooklyn, New York 11235-0001
September 6, 2012
2013
Tony Justice
SAMPLE