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

VPUCCIARELLI@MSN.COM

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

anthony.pucciarelli@mail.cuny.edu

vpucciarelli@msn.com

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